Chiarini, Giovanni and Mariani, Silvia and Schaefer, Anne-Kristin and van Bussel, Bas C. T. and Di Mauro, Michele and Wiedemann, Dominik and Saeed, Diyar and Pozzi, Matteo and Botta, Luca and Boeken, Udo and Samalavicius, Robertas and Bounader, Karl and Hou, Xiaotong and Bunge, Jeroen J. H. and Buscher, Hergen and Salazar, Leonardo and Meyns, Bart and Herr, Daniel and Matteucci, Sacha and Sponga, Sandro and Ramanathan, Kollengode and Russo, Claudio and Formica, Francesco and Sakiyalak, Pranya and Fiore, Antonio and Camboni, Daniele and Raffa, Giuseppe Maria and Diaz, Rodrigo and Wang, I-wen and Jung, Jae-Seung and Belohlavek, Jan and Pellegrino, Vin and Bianchi, Giacomo and Pettinari, Matteo and Barbone, Alessandro and Garcia, Jose P. and Shekar, Kiran and Whitman, Glenn J. R. (2024) Neurologic complications in patients receiving aortic versus subclavian versus femoral arterial cannulation for post-cardiotomy extracorporeal life support: results of the PELS observational multicenter study. CRITICAL CARE, 28 (1): 265. ISSN 1364-8535, 1466-609X
Full text not available from this repository. (Request a copy)Abstract
Background Cerebral perfusion may change depending on arterial cannulation site and may affect the incidence of neurologic adverse events in post-cardiotomy extracorporeal life support (ECLS). The current study compares patients' neurologic outcomes with three commonly used arterial cannulation strategies (aortic vs. subclavian/axillary vs. femoral artery) to evaluate if each ECLS configuration is associated with different rates of neurologic complications. Methods This retrospective, multicenter (34 centers), observational study included adults requiring post-cardiotomy ECLS between January 2000 and December 2020 present in the Post-Cardiotomy Extracorporeal Life Support (PELS) Study database. Patients with Aortic, Subclavian/Axillary and Femoral cannulation were compared on the incidence of a composite neurological end-point (ischemic stroke, cerebral hemorrhage, brain edema). Secondary outcomes were overall in-hospital mortality, neurologic complications as cause of in-hospital death, and post-operative minor neurologic complications (seizures). Association between cannulation and neurological outcomes were investigated through linear mixed-effects models. Results This study included 1897 patients comprising 26.5% Aortic (n = 503), 20.9% Subclavian/Axillary (n = 397) and 52.6% Femoral (n = 997) cannulations. The Subclavian/Axillary group featured a more frequent history of hypertension, smoking, diabetes, previous myocardial infarction, dialysis, peripheral artery disease and previous stroke. Neuro-monitoring was used infrequently in all groups. Major neurologic complications were more frequent in Subclavian/Axillary (Aortic: n = 79, 15.8%; Subclavian/Axillary: n = 78, 19.6%; Femoral: n = 118, 11.9%; p < 0.001) also after mixed-effects model adjustment (OR 1.53 [95% CI 1.02-2.31], p = 0.041). Seizures were more common in Subclavian/Axillary (n = 13, 3.4%) than Aortic (n = 9, 1.8%) and Femoral cannulation (n = 12, 1.3%, p = 0.036). In-hospital mortality was higher after Aortic cannulation (Aortic: n = 344, 68.4%, Subclavian/Axillary: n = 223, 56.2%, Femoral: n = 587, 58.9%, p < 0.001), as shown by Kaplan-Meier curves. Anyhow, neurologic cause of death (Aortic: n = 12, 3.9%, Subclavian/Axillary: n = 14, 6.6%, Femoral: n = 28, 5.0%, p = 0.433) was similar. Conclusions In this analysis of the PELS Study, Subclavian/Axillary cannulation was associated with higher rates of major neurologic complications and seizures. In-hospital mortality was higher after Aortic cannulation, despite no significant differences in incidence of neurological cause of death in these patients. These results encourage vigilance for neurologic complications and neuromonitoring use in patients on ECLS, especially with Subclavian/Axillary cannulation.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MEMBRANE-OXYGENATION; ADULT PATIENTS; INJURY; GUIDELINES; Extracorporeal membrane oxygenation; Cardiac surgery; Neurologic complications; Cardiac arrest; Stroke; ICH |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 24 Jul 2025 09:38 |
| Last Modified: | 24 Jul 2025 09:38 |
| URI: | https://pred.uni-regensburg.de/id/eprint/65730 |
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