Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation.
OBJECTIVE
To facilitate venoarterial extracorporeal membrane oxygenation (ECMO) insertion for cardiogenic shock, we recently adopted a strategy of using a 15F arterial cannula in all patients, rather than 1 designed to maximize flow. We aimed to compare the clinical outcomes of these 2 strategies.


METHODS
In this retrospective study, 101 consecutive patients supported with ECMO via femoral cannulation between March 2007 and March 2013 were divided into 2 groups: Group L (17F-24F arterial cannula to accommodate full flow [ie, cardiac index of 2.5 L/m(2)/min]; n = 51) and Group S (15F arterial cannula; n = 50). The primary outcomes of interest were patients' overall status at 24 hours of support and cannulation-related adverse events.


RESULTS
There were no significant differences in patient demographics, etiology of cardiogenic shock, or severity of illness before ECMO initiation between the 2 groups. Group L had significantly higher ECMO flow than Group S (flow index at 24 hours: 2.2 ± 0.7 vs 1.7 ± 0.3 L/m(2)/min; P < .001). However, there was no significant difference in use of vasoactive medication/hemodynamic parameters/laboratory parameters. Group L had higher incidence of cannulation-related adverse events (35% vs 22% in Group S [P = .14]), particularly in cannulation site bleeding (28% vs 10% [P = .03]). Thirty-day survival was 55% in Group L versus 52% in Group S (P = .77). Bleeding complication occurred in 53% in Group L versus 32% in Group S (P = .03).


CONCLUSIONS
Compared with the use of larger cannulas, ECMO with a 15F arterial cannula appears to provide comparable clinical support with reduced bleeding complications.
Department of Surgery, Columbia University Medical Center, New York, NY. Electronic address: hirofu2@hotmail.com.
Hiroo
H
Takayama
Department of Surgery, Columbia University Medical Center, New York, NY.
Elissa
E
Landes
Department of Surgery, Columbia University Medical Center, New York, NY.
Lauren
L
Truby
Department of Surgery, Columbia University Medical Center, New York, NY.
Kevin
K
Fujita
Department of Medicine, Columbia University Medical Center, New York, NY.
Ajay J
AJ
Kirtane
Department of Surgery, Columbia University Medical Center, New York, NY.
Linda
L
Mongero
Department of Medicine, Columbia University Medical Center, New York, NY.
Melana
M
Yuzefpolskaya
Department of Medicine, Columbia University Medical Center, New York, NY.
Paolo C
PC
Colombo
Department of Medicine, Columbia University Medical Center, New York, NY.
Ulrich P
UP
Jorde
Department of Surgery, Columbia University Medical Center, New York, NY.
Paul A
PA
Kurlansky
Department of Surgery, Columbia University Medical Center, New York, NY.
Koji
K
Takeda
Department of Surgery, Columbia University Medical Center, New York, NY.
Yoshifumi
Y
Naka
D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices
ECMO; cardiogenic shock; complications