Impact of Cannulation Strategies on Veno-arterial Extracorporeal Membrane Oxygenation Complications--A Single Center Retrospective Study / 中国循环杂志

ABSTRACT

Objectives: To observe the impact of cannulation strategies on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) complications. Methods: A total of 37 patients with refractory heart failure (HF) treated in our hospital from 2007 to 2016 were enrolled. All patients received VA-ECMO with ipsilateral femoral artery and vein cannulation and they were divided into 2 groups Direct cannulation group, patients received open surgery for femoral artery and vein cannulation directly, based on downstream leg ischemia condition, ARROW sheath was used in ECMO pipeline to establish collateral circulation, n=21 and "Chimney technique" group, patients received femoral vessel cannulation as a graft of 8 mm Dacron artificial vessel was end-to-side anastomosed to the host femoral artery, then was connected to the host femoral vein directly, n=16. Prior ECMO clinical condition, time of cannulation, duration of VA-ECMO, the mean amounts of daily bleeding and transfusion, downstream leg ischemia condition and in-hospital mortality were observed and compared between 2 groups. Results: Compared with Direct cannulation group, "Chimney technique" group showed the longer time of cannulation (83.54±13.2) min vs (67.33±22.4) min, P<0.05, less patients with downstream leg ischemia (6.2% vs 23.8%), less amounts of daily bleeding (210.78±180.22) ml vs (560.76±220.23) ml and transfusion (3.11±1.65) U vs (6.37±2.44) U, all P<0.01; the in-hospital mortality was similar between 2 groups (62.5% vs 61.9%), P>0.05. Conclusions: "Chimney technique" of VA-ECMO improved the downstream leg ischemia and bleeding, while the in-hospital mortality was similar to direct cannulation in relevant patients.