Cannulation-Related Adverse Events of Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Support in Heart Transplantation: Axillary versus Femoral Artery Cannulation

Authors

Suguru Ohira, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA.Follow
Abhay Dhand, New York Medical College, Valhalla, New York, USA.Follow
Rahim Hirani, New York Medical College, Valhalla, New York, USA.
Sabrina Martinez, New York Medical College, Valhalla, New York, USA.Follow
Gregg M. Lanier, New York Medical College, Valhalla, New York, USA.Follow
Avi Levine, New York Medical College, Valhalla, New York, USA.Follow
Stephen Pan, New York Medical College, Valhalla, New York, USA.Follow
Chhaya Aggarwal-Gupta, New York Medical College, Valhalla, New York, USA.Follow
Alan L. Gass, New York Medical College, Valhalla, New York, USA.Follow
Kevin Wolfe, Division of Data Compliance, Transplant Services, Westchester Medical Center, Valhalla, New York, USA.
David Spielvogel, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA.
Masashi Kai, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA.Follow

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

Keywords

ECMO, axillary artery, cannulation, femoral artery, heart transplant

Disciplines

Medicine and Health Sciences

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