Peripheral versus central cannulation for extracorporeal membrane oxygenation: a comparison of limb ischemia and transfusion requirements.
BACKGROUND
Extracorporeal membrane oxygenation (ECMO) can be instituted centrally, through the right atrium and ascending aorta, or peripherally, most commonly using the femoral artery and vein. We sought to investigate the impact of the mode of cannulation on the incidence of limb ischemia, perfusion and overall morbidity.


METHODS
A retrospective analysis of 50 consecutive patients over 5 years who underwent ECMO by central or peripheral cannulation was performed.


RESULTS
There was no difference in the incidence of limb ischemia and end-organ perfusion when peripheral and central cannulation cohorts were compared. Central cannulation was associated with a higher incidence of bleeding from the cannulation site (64% vs. 18%, P = 0.002), blood product utilization and reoperation (66% vs. 14%, P < 0.0001). 30-day mortality was similar in both cohorts (46% peripheral, 50% central, P = 0.8).


CONCLUSIONS
Our results suggest that there is comparable tissue perfusion and limb ischemia with both cannulation techniques. Central cannulation is associated with a higher incidence of bleeding, higher transfusion rates, a greater need for reoperation and greater resource utilization. Therefore, peripheral cannulation is safe and may be advantageous in certain clinical scenarios.
Division of Cardiac Surgery, University of Alberta, Edmonton, Canada. hdkanji@gmail.com
H D
HD
Kanji
C J
CJ
Schulze
A
A
Oreopoulos
E J
EJ
Lehr
W
W
Wang
R M
RM
MacArthur
D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000401:mortality; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000401:mortality; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005121:Extremities / Q000098:blood supply*; D005260:Female; D005263:Femoral Artery; D005268:Femoral Vein; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome