One-year experience of bedside percutaneous VA-ECMO decannulation in a high-ECMO-volume center in Hong Kong

Abstract

Background: When veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support can be terminated, open repair of arteriotomy wounds in operating theaters is the standard of practice. Comparable outcomes by percutaneous decannulation using different closure devices have been reported. However, transport of the critically- ill, man-power and timeslots of operating theaters could be saved if decannulation was performed at bedside. Method: Bedside percutaneous arteriotomy wound closure became our default method of decannulation since November 2018. We reviewed our 1-year data to evaluate if such practice could be safely adopted in a local high-ECMO-volume center. Results: Between November 2018 and October 2019, 25 patients had their VA-ECMO terminated at the bedside. Twenty-one patients (84%) had successful decannulation. For those who failed, emergency open repair resulted in no additional complications. Two ProGlide devices were used in 15 (71.4%) patients and three were used in 6 (28.6%) patients. The procedure time was 27 (15–45) min. The median blood loss was 300 mL (250–400). Minor complications were found in 4 (19.1%) patients, including two arterial clot formation, one pseudoaneurysm and one wound infection. There were no other major complications. Conclusion: Our 1-year experience showed that percutaneous bedside VA-ECMO decannulation was feasible to commence in a local large-ECMO-volume center.

Preclosure technique versus arterial cutdown after percutaneous cannulation for venoarterial extracorporeal membrane oxygenation

“…However, site infection after cannula removal was uncommon (2.0%) in the preclosure group of our cohort and this rate was comparable to those demonstrated in postclosure following decannulation of VA-ECMO. 4,6,7 Further, in a previous study of the use of the preclosure technique in elective peripheral VA-ECMO before lung transplantation, similarly low rates of site infections were noted. 14 Historically, it has been typical to perform surgical vascular repair with exposure and repair of the common femoral artery at the time of decannulation from VA-ECMO.…”

“…However, these techniques have not yet demonstrated improvements in clinical outcomes compared with surgical removal in this setting. [4][5][6][7][8] We suspect postclosure compared with preclosure may result in a more technically challenging VA-ECMO decannulation procedure and be prone to excessive blood loss when attempting to deploy the suture device after large-bore arterial access such as provided with VA-ECMO. It has been suggested that a possible…”

“…However, these techniques have not yet demonstrated improvements in clinical outcomes compared with surgical removal in this setting. 4 , 5 , 6 , 7 , 8 We suspect postclosure compared with preclosure may result in a more technically challenging VA-ECMO decannulation procedure and be prone to excessive blood loss when attempting to deploy the suture device after large-bore arterial access such as provided with VA-ECMO. It has been suggested that a possible advantage of the postclosure technique compared with preclosure in VA-ECMO is that, given the uncertain duration of extracorporeal therapy, suture-mediated system stitches may remain in place and be subject to infection for prolonged periods of time.…”

“… 3 In an effort to reduce the rates of vascular complications at the time of VA-ECMO decannulation and to avoid the need for traditional surgical vascular repair, percutaneous techniques for closure of arterial cannulation sites utilizing suture-mediated closure systems have been employed by a number of centers. 4 , 5 , 6 , 7 , 8 Likewise, suture-mediated closures systems have been utilized for safe and successful closure of large-bore venous and arterial access sites following a variety of elective vascular procedures including the elective use of VA-ECMO before lung transplantation. 9 , 10 , 11 , 12 , 13 , 14 The Perclose ProGlide (Abbott Vascular, Abbott Park, Ill) is 1 such suture-mediated closure system.…”

Comparing the outcomes of bedside percutaneous VA‐ECMO decannulation by ProGlide and Manta in a high‐ECMO‐volume center in Hong Kong

“…However, the transport of critically ill patients on VA‐ECMO support is not without risk. Nowadays, an increasing number of centers have been practicing VA‐ECMO decannulation with different percutaneous closure devices 2–8 . This has resulted in relatively smaller wounds and fewer incidences of wound infections.…”