NYMC Faculty Publications
Cannulation-Related Adverse Events of Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Support in Heart Transplantation: Axillary versus Femoral Artery Cannulation
Author Type(s)
Student, Faculty
DOI
10.1111/ctr.14871
Journal Title
Clinical Transplantation
First Page
e14871
Document Type
Article
Publication Date
3-1-2023
Department
Surgery
Second Department
Medicine
Abstract
BACKGROUND: In heart transplantation (HT), peripheral veno-arterial extracorporeal membranous oxygenation (VA-ECMO) is utilized preoperatively as a direct bridge to HT or postoperatively for primary graft dysfunction (PGD). Little is known about wound complications of an arterial VA-ECMO cannulation site which can be fatal. METHODS: From 2009 to 2021, outcomes of 80 HT recipients who were supported with peripheral VA-ECMO either preoperatively or postoperatively were compared based on the site of arterial cannulation: axillary (AX: N = 49) versus femoral artery (FA: N = 31). RESULTS: Patients in the AX group were older (AX: 59 years vs. 52 years, p = .006), and less likely to have extracorporeal cardiopulmonary resuscitation (0% vs. 12.9%, p = .040). Survival to discharge (AX, 81.6% vs. FA. 90.3%, p = .460), incidence of stroke (10.2% vs. 6.5%, p = .863), VA-ECMO cannulation-related bleeding (6.1% vs. 12.9%, p = .522), and arm or limb ischemia (0% vs. 3.2%, p = .816) were comparable. ECMO cannulation-related wound complications were lower in the AX group (AX, 4.1% vs. FA, 45.2%, p < .001) including the wound infections (2.0% vs. 32.3%, p < .001). In FA group, all organisms were gram-negative species. In univariate logistic regression analysis, AX cannulation was associated with less ECMO cannulation-related wound complications (Odds ratio, .23, p < .001). There was no difference between cutdown and percutaneous FA insertion regarding cannulation-related complications. CONCLUSIONS: Given the lower rate of wound complications and comparable hospital outcomes with femoral cannulation, axillary VA-ECMO may be an excellent option in HT candidates or recipients when possible.
Recommended Citation
Ohira, S., Dhand, A., Hirani, R., Martinez, S., Lanier, G. M., Levine, A., Pan, S., Aggarwal-Gupta, C., Gass, A. L., Wolfe, K., Spielvogel, D., & Kai, M. (2023). Cannulation-Related Adverse Events of Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Support in Heart Transplantation: Axillary versus Femoral Artery Cannulation. Clinical Transplantation, 37 (3), e14871. https://doi.org/10.1111/ctr.14871