Percutaneous Decannulation Instead of Surgical Removal for Weaning After Venoarterial Extracorporeal Membrane Oxygenation—A Crossed Perclose ProGlide Closure Device Technique Using a Hemostasis Valve Y Connector

Abstract

Objectives: Improvements in cannula removal techniques, and in particular a standardized decannulation technique with a suitable closure device, are needed to further improve patients’ outcomes after percutaneous cannulation. The decannulation techniques described so far are neither sufficiently standardized nor proven enough to be used in the large group of venoarterial extracorporeal membrane oxygenation patients. To meet this challenge, we have established a highly standardized and safe decannulation technique based on the Perclose ProGlide closure system (Abbott Vascular, Lake Bluff, IL). Design: Establishment of a highly standardized and safe decannulation technique based on the Perclose ProGlide closure system, which is described in detail with comprehensive instructions for the executive clinician and first application in the context of a pilot study. Measurements and Main Results: So far our technique has already been used successfully in seven patients since January 2019 as a standard procedure on our ICU with only one minor complication occurred after the first procedure, that is, a small pseudoaneurysm likely originating from antegrade perfusion puncture site which was sealed by thrombin injection. Conclusions: Our crossed ProGlide technique using a hemostasis valve Y connector ensuring no blood loss seems to be a very promising decannulation technique.

Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation

“…Once the lowest ECMO flow rate has been reached, at least 12 h of stable hemodynamics is required before final de-cannulation is performed. For de-cannulation itself, we use percutaneous closure devices at bedside in ICU, making resource demanding and stressful transport to the operating room unnecessary [56]. Of course, one important part of every weaning strategy should be the anticipation of failure.…”

Complete percutaneous angio-guided approach using preclosing for venoarterial extracorporeal membrane oxygenation implantation and explantation in patients with refractory cardiogenic shock or cardiac arrest

“…The Manta ® vascular closure device (VCD ® , Teleflex, Morrisville, USA) has been used in several case reports and in a cohort of 16 patients with good results regarding hemostasis but with a rather high rate of arterial stenosis or thrombosis following vascular closure (27.3%) [ 13 ]. The Perclose ProGlide ® closure device has been studied for post-closing with a rate of failure between 5 and 15% and the use of 2 to 4 devices [ 14 , 15 ]. This technique is attractive although in large bore vascular access, the needles of the Perclose ProGlide ® sometimes do not perforate the vessel wall, making percutaneous closure impossible.…”

“…Regarding removal, surgical femoral cutdown is considered as standard practice but frequently associated with severe complications such as hemorrhage, delayed wound healing and infections [ 11 , 12 ]. Other techniques such as manual compression or post-closing using closing devices have been described but none of these are ideal [ 10 , 11 , 13 – 15 ]. Hence, decannulation remains at risks of complications because of the lack of standardized approach.…”

Venoarterial extracorporeal membrane oxygenation as bridge to effective treatment in a 19-year-old woman with acute adrenal crisis: a case report

“…by using closure devices. 19 This is particularly advantageous if a temporary and reversible cardiac dysfunction due to an Addison crisis can be assumed.…”