ABSTRACT
Purpose: Venovenous extracorporeal membrane oxygenation (VV-ECMO) is performed through various cannulation approaches but an optimal strategy remains uncertain. Methods: A retrospective, multi-center study was conducted. Adult patients (≥18 years old) placed on VV-ECMO for severe respiratory failure due to COVID-19 between March 1, 2020, to April 30, 2021, across the United States were included. Patients were divided into the following 3 groups based on initial cannulation: 1) femoral vein-femoral vein or femoral vein-internal jugular vein (Dual-Site, DS), 2) single, dual-lumen cannula in internal jugular vein with tip positioned in the pulmonary artery (PA) and 3) single, dual-lumen cannula in internal jugular vein with tip positioned in the inferior vena cava (IVC). The primary outcome was in-hospital mortality after VV-ECMO placement assessed by a time-toevent analysis. Results: Overall, 435 patients from 17 centers comprised the study cohort. DS cannulation was performed in 247 (age: 47±11, 30% female) cases, 99 (age 50±12, 26% female) received PA, and 89 patients got IVC (age 45±12, 33% female). At 90 days, in-hospital mortality across cannulation groups was 60% (DS), 41% (PA) and 61% (IVC), p=0.06 (Figure 1). After adjustment for clinical covariates, the likelihood of in-hospital mortality in comparison to DS, was lower with PA (aHR: 0.60, 95%CI 0.40-0.91, p=0.02) and similar with IVC (aHR: 0.99, 95%CI 0.68-1.43, p=0.95). Conclusion: Catheter directed flow into the PA with a single dual-lumen cannula is associated with reduced mortality during VV ECMO for COVID-19.