Effect of ultrasonography and fluoroscopic guidance on the incidence of complications of cannulation in extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a retrospective observational study

Abstract

BackgroundIt remains unclear which cannulation method is best in cases of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest. We assessed the effect of ultrasound- and fluoroscopy-guided percutaneous cannulation on complication incidence, compared with that using only ultrasound guidance.MethodsThis single-center retrospective observational study was conducted between February 2011 and December 2015. In the comparison group, cannulation was performed percutaneously using only ultrasound guidance. In the exposure group, cannulation was performed percutaneously using fluoroscopy and ultrasound guidance. The primary outcome assessed was whether complications were associated with cannulation. The secondary outcome assessed was the duration from hospital arrival to extracorporeal circulation start. In addition to univariate analysis, multivariate logistic-regression analysis for cannulation complications was performed to adjust for several presumed confounders.ResultsOf the patients who underwent ECPR, 73 were eligible; the comparison group included 50 cases and the exposure group included 23 cases. Univariate analysis showed that the complication incidence of the exposure group was significantly lower than that of the comparison group (8.7 vs. 36.0%, p = 0.022). Duration from hospital arrival to extracorporeal circulation start was almost the same in both groups (median, 17.0 min vs. 17.0 min, p = 0.92). After multivariate logistic regression analysis, cannulation using fluoroscopy and ultrasound was independently associated with a lower complication incidence (adjusted odds ratio, 0.14; p = 0.024).ConclusionsUltrasound- and fluoroscopy-guided cannulation may reduce the complication incidence of cannulation without delaying extracorporeal circulation start.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0293-z) contains supplementary material, which is available to authorized users.

Extracorporeal membrane oxygenation improved survival in patients with massive pulmonary embolism

“…Imaging modalities, including ultrasound and fluoroscopy can reduce vascular complications. 20 Therefore, we should actively utilize imaging modalities to reduce bleeding events for ECMO cannulation. In our study, there were no differences in baseline characteristics, ECMO complications, and transfusion between survivors and non-survivors in the stage 2 group.…”

Near-fatal negative pressure pulmonary oedema successfully treated with venovenous extracorporeal membrane oxygenation performed in the hybrid emergency room

“…Further, a retrospective study demonstrated that a hybrid ER significantly reduced the incidence of complications of cannulation of ECMO. 15 Thus, we could initiate ECMO within 18 min of arrival in the hybrid ER without any complication which prevented him from going into a cardiopulmonary Patient's perspective I remember that I was very surprised to hear that I was about to die. I do not really remember the days I spent in Saiseikai Yokohamashi Tobu Hospital.…”

“…Further, a retrospective study demonstrated that a hybrid ER significantly reduced the incidence of complications of cannulation of ECMO. 15 Thus, we could initiate ECMO within 18 min of arrival in the hybrid ER without any complication which prevented him from going into a cardiopulmonary arrest. Meanwhile, there are several issues such as the implementation cost, complexity and indication.…”

Current Image-Guided Interventions in Pediatric Surgery

“…11 Similarly, one series found there was a statistically significant decrease in complication rate when US or fluoroscopy was used to place ECMO cannulas without delaying ECMO circuit start time. 12…”