Management of dead space thrombosis during decannulation of peripherally inserted venoarterial extracorporeal membrane oxygenation

Sulimov, Dmitry; Markuske, Matthias; Desch, Steffen; Thiele, Holger

doi:10.1002/ccd.29595

Cited by 8 publications

(9 citation statements)

References 4 publications

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“…Femoral cut-down and thrombectomy, for long indwelled cannulas, are justified given the propensity for the femoral artery portion (dead space) between the arterial and limb perfusion cannulas to thrombose, if ECMO run is prolonged. 11 We did not observe any bleeding tendency after percutaneous ultrasound-guided MANTA closure. According to Hwang et al, 12 employing the suture based ProGlide for percutaneous decannulation, a higher bleeding tendency apparently contributed to lower hemoglobin in surgically decannulated patients after weaning than in percutaneously decannulated patients.…”

Section: Discussionmentioning

confidence: 51%

“…In comparison, the ProGlide device’s technical success has been reported to be 84.0%–95.8%. 10 –13 The single VCD failure in our study was likely caused by weakened vessels due to prolonged ECMO duration and indwelling of cannulas (25 days). Angio-Seal used for limb perfusion arteriotomy closure in the superficial femoral artery failed similarly (type 4 VCD failure), 2 supporting the theory.…”

Section: Discussionmentioning

confidence: 84%

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Ultrasound-guided closure of the femoral artery during venoarterial decannulation using a large-bore closure device

et al. 2023

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Background: Peripheral femoro-femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is viable for fast hemodynamic assistance during cardiogenic shock. Ultrasound-guided closure with a large-bore device (MANTA®) is a feasible option potentially replacing surgical arteriotomy closure in peripheral VA-ECMO decannulation. Methods: This retrospective study included patients weaning from percutaneously inserted femoro-femoral VA-ECMO at the Helsinki University Hospital, Finland in 2012–2020. The primary endpoints were access-site complications, a composite of hematomas/seromas/surgical site infections (SSIs), and the safety endpoint of vascular complications (VCs). Results: A total of 100 consecutive percutaneously implanted and weaned VA-ECMO patients were stratified into two groups by decannulation strategy: percutaneous ultrasound-guided MANTA device ( n = 21, 21.0%) or surgical approach ( n = 79, 79.0%). The mean age of the cohort was 51 ± 13 years and females represented 25.0%. The technical success rate of the percutaneous ultrasound-guided MANTA technique was 95.2%. In multivariate analysis, surgical closure was associated with a higher incidence of combined access site hematomas/seromas/SSIs compared to percutaneous ultrasound-guided deployment of MANTA device (44.3% versus 9.5%, odds ratio (OR): 7.162, 95% confidence interval (CI): 1.544–33.222; p = 0.012). Similarly, access-site complications necessitating interventions were more frequent in the surgical closure group compared to US-MANTA (ultrasound-guided MANTA) group (26.6% versus 0.0%, p = 0.005). VCs were infrequent in both groups without any significant intergroup difference ( p > 0.99). Conclusions: Percutaneous ultrasound-guided MANTA closure of the femoral artery after VA-ECMO decannulation was associated with high technical success rate and low incidence of VCs. Compared to surgical closure, access-site complications were significantly less frequent, along with access-site complications necessitating interventions.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 84%

Ultrasound-guided closure of the femoral artery during venoarterial decannulation using a large-bore closure device

et al. 2023

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“…It should be kept in mind that a small, non-perfused space forms between the large bore arterial cannula and the antegrade sheath, which can promote thrombus formation leading to possible thromboembolic complications during VA-ECMO removal. Recently, a technique to flush this non-perfused space during removal procedure was introduced to further reduce the rate of limb ischemia [ 57 ].…”

Section: Complications Of Va-ecmo Therapymentioning

confidence: 99%

“…In the case of peripheral cannulation, different options to achieve hemostasis are available. As described above, attention should be paid to the developing dead-space between the arterial cannula and the antegrade sheath during decannulation [ 57 ]. The former standard was placement of a femoral compression system during decannulation.…”

Section: Weaning and Decannulationmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Infarct-Related Cardiogenic Shock

Freund

Desch

Pöss

et al. 2022

JCM

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Mortality in infarct-related cardiogenic shock (CS) remains high, reaching 40–50%. In refractory CS, active mechanical circulatory support devices including veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are rapidly evolving. However, supporting evidence of VA-ECMO therapy in infarct-related CS is low. The current review aims to give an overview on the basics of VA-ECMO therapy, current evidence, ongoing trials, patient selection and potential complications.

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“…2 of 10 ischemia due to thrombosis could be high even after decannulation. Arterial thrombosis formation in VA-ECMO is potentially higher in the low-flow space segment because of the low blood flow between the arterial cannula and the distal perfusion cannula [4,9,10] (Figure 1). The consequence of arterial lumen occlusion, if left unnoticed and inappropriately managed, could result in acute limb ischemia [4].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Cannula-associated Arterial Thrombosis following Extracorporeal Membrane Oxygenation support: A Retrospective Study

Trieu¹,

Phan²,

Tran³

et al. 2023

Preprint

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Introduction: Hemostatic dysfunction during extracorporeal membrane oxygenation (ECMO) due to blood-circuit interaction and the consequences of shear stress by flow rates lead to rapid activation of the coagulation cascade and thrombus formation in the ECMO system and blood vessels. In this study, we aimed to identify the incidence and risk factors for cannula-associated arterial thrombosis (CaAT) post-decannulation. Methods: A retrospective study of patients undergoing arterial cannula removal following ECMO. We evaluated the incidence of CaAT and compared clinical characteristics, pre-ECMO severity, and daily hemostasis parameters in patients with and without CaAT. Multivariate analysis revealed the risk factors for CaAT. Results: Forty-seven patients requiring venoarterial ECMO or hybrid methods were recruited to be screened for thrombosis. The median SOFA score was 11 (8-13). CaAT occurred in 29 patients (61.7%), with thrombosis in the superficial femoral artery accounting for 51.7%. Limb ischemia complications in the group with CaAT was 17.2%. In multivariate analysis, an ECMO flow rate of 100 mL/min was determined to be the independent factor for CaAT with an OR of 0.84 (95% CI, 0.73–0.95, p=0.008). Conclusion: In patients successfully weaned from ECMO, the incidence of CaAT was 61.7%. Our study found that a low-flow rate of ECMO was an independent risk factor for CaAT.

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Management of dead space thrombosis during decannulation of peripherally inserted venoarterial extracorporeal membrane oxygenation

Cited by 8 publications

References 4 publications

Ultrasound-guided closure of the femoral artery during venoarterial decannulation using a large-bore closure device

Ultrasound-guided closure of the femoral artery during venoarterial decannulation using a large-bore closure device

Extracorporeal Membrane Oxygenation in Infarct-Related Cardiogenic Shock

Risk Factors of Cannula-associated Arterial Thrombosis following Extracorporeal Membrane Oxygenation support: A Retrospective Study

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