Cannulation-Related Complications on Veno-Arterial Extracorporeal Membrane Oxygenation: Prevalence and Effect on Mortality

Abstract

Cannulation-related complications are a known source of morbidity in patients supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Despite its prevalence, little is known regarding the outcomes of patients who suffer such complications. This is a single institution review of cannulation-related complications and its effect on mortality in patients supported on VA-ECMO from January 2010-2015 using three cannulation strategies: axillary, femoral, and central. Complications were defined as advanced if they required major interventions (fasciotomy, amputation, site conversion). Patients were divided into two groups (complication present vs. not present) and Kaplan-Meier analysis was performed to determine any differences in their survival distributions. There were 103 patients supported on VA-ECMO: 41 (40%), 36 (35%), and 26 (25%) were cannulated via axillary, femoral, and central access, respectively. Cannulation-related complications occurred in 33 (32%) patients and this did not differ significantly between either axillary (34%), femoral (36%), or central (23%) strategies (P = 0.52). The most common complications encountered were hemorrhage and limb ischemia in 19 (18%) and 11 (11%) patients. Hemorrhagic complications did not differ between groups (P = 0.37), while limb ischemia and hyperperfusion were significantly associated with femoral and axillary cannulation, at a rate of 25% (P < 0.01) and 15% (P = 0.01), respectively. There was no difference in the incidence of advanced complications between cannulation groups: axillary (12%) vs. femoral (14%) vs. central (8%; P = 0.75). In addition, no increase in mortality was noted in patients who developed a cannulation-related complication by Kaplan-Meier estimates (P = 0.37). Cannulation-related complications affect a significant proportion of patients supported on VA-ECMO but do not differ in incidence between different cannulation strategies and do not affect patient mortality. Improved efforts at preventing these complications need to be developed to avoid the additional morbidity in an already critical patient population.

The impact of interleukin serum levels on the prognosis of patients undergoing venoarterial extracorporeal membrane oxygenation

“…Demographic data, underlying diseases, complications, and outcomes of the present patient cohort are consistent with published data of patients undergoing VA ECMO due to refractory cardiogenic shock or CPR without the occurrence of ROSC. 1,14,15 The comparison of factors associated with the outcome of ECLS patients between survivors and nonsurvivors showed no significant differences between the groups, with the exception of the incidence of CPR prior to VA ECMO initiation and duration of VA ECMO. To rule out CPR as a prognostic variable determined by the analysis of interleukins, all patients who underwent CPR prior to ECLS were divided into survivor and nonsurvivor groups, followed by an analog analysis of interleukins as in the entire patient cohort.…”

Adult cardiac veno-arterial extracorporeal life support (VA-ECMO): prevention and management of acute complications

“…Large diameter ECMO cannulas should be considered if placing peripherally, however, this can be self-limiting for this type of approach, and central cannulation may be a better option if needed. If conservative methods are not sufficient, other methods to assist with decreasing blood volume should be considered, including the placement of an LV or LA venting catheter, atrial septostomy, trans-aortic catheter venting, venting via pulmonary artery drainage, and indirect LV venting via IABP, TandemHeart, or Impella (12,13,19,32).…”

“…Complications can vary depending on the cannulation approach used, with bleeding occurring most frequently, in femoral, central, and axillary techniques. Pseudoaneurysm has also been reported, primarily after removal of femoral peripheral cannulas (19). This may necessitate the need for surgical repair if extensive.…”

Intravascular Folding of a Peripheral Venous VA‐ECMO Cannula for Extracorporeal Cardiopulmonary Resuscitation

“…To the Editor, The recent observational study by Wong et al reveals a high number of cannula associated complications (32%) for patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiopulmonary failure (1). We were encouraged to read that in this cohort there was no association between cannula associated complications and mortality.…”