title: Femoro-femoral versus atrio-aortic extracorporeal membrane oxygenation: selecting the ideal cannulation technique.
abstract: Veno-arterial extracorporeal membrane oxygenation (ECMO) may be implanted using peripheral ECMO (pECMO) or central ECMO (cECMO) cannulation techniques. The aim of this study was to compare the outcome between these two cannulation techniques. A retrospective study was performed at Düsseldorf University Hospital from October 2009 through June 2011. Inclusion criteria were patients with veno-arterial ECMO support ≥24 h. Various pre- and postimplantation variables were investigated including postimplantation hemodynamic and ECMO parameters, oxygenation/ventilation parameters at 3, 6, 12, 24, 48, 72 h, as well as renal and liver function tests at first and third postoperative days following implantation. Outcome data of patients receiving pECMO were compared with those who received cECMO. The inclusion criteria were met by 37 patients (25 pECMO and 12 cECMO). There were no significant differences in baseline characteristics between these two groups except for younger age in pECMO patients (P=0.005). All postimplantation variables were comparable between the two groups except for higher PO2 and lower PCO2 values at the 3rd hour postimplantation in patients with pECMO (P=0.007 and 0.01, respectively). Eleven (44%) of the pECMO patients required re-exploration for bleeding versus 100% of patients with cECMO (P=0.01). Ischemic leg complication was observed in four pECMO and three cECMO patients. Thirty-day mortality in patients with pECMO and cECMO was 60% versus 67%, respectively (P=1.00). In this study, no particular oxygenation/ventilation, hemodymanic, or end-organ function advantage was observed with either cannulation technique. However, more bleeding and resternotomy complications were observed in cECMO patients.
authors.affiliation: Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Diyar
authors.initials: D
authors.lastname: Saeed
authors.forename: Hanna
authors.initials: H
authors.lastname: Stosik
authors.forename: Merima
authors.initials: M
authors.lastname: Islamovic
authors.forename: Alexander
authors.initials: A
authors.lastname: Albert
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kamiya
authors.forename: Bujar
authors.initials: B
authors.lastname: Maxhera
authors.forename: Artur
authors.initials: A
authors.lastname: Lichtenberg
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000209:etiology; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016896:Treatment Outcome
keywords: Cannulation technique; Cardiac surgery; Extracorporeal membrane oxygenation