title: Vascular Complications Arising from Hemostasis with Manual Compression Following Extracorporeal Membrane Oxygenation Decannulation.
abstract: BACKGROUND
  We evaluated the vascular complications and success rate of manual compression in achieving hemostasis and access site closure after transfemoral arterial extracorporeal membrane oxygenation (ECMO) decannulation.
  
  
  METHODS
  Between February 2010 and July 2014, 63 patients who underwent veno-arterial ECMO were retrospectively studied. Patients who developed postprocedural vascular complications after manual compression were identified, and the hemostasis success rate was evaluated.
  
  
  RESULTS
  The overall manual compression success rate was 95.2%. Eleven patients (17.5%) developed vascular complications: hematoma (more than 5 cm) occurred in six patients (9.5%) who were treated with repeat manual compression. Retroperitoneal bleeding occurred in one patient, requiring abdominal hematoma evacuation surgery. One patient (1.6%) developed access site bleeding, requiring suturing. One patient (1.6%) developed an arteriovenous fistula (AVF). Two patients (3.2%) had a pseudoaneurysm, of whom one was treated with sclerotherapy in the femoral artery; the other patient and the AVF patient were treated with repeat manual compression. The hematoma rate was significantly higher in patients with an activated partial thromboplastin time (aPTT) >56, and in whom dual antiplatelet drugs were used (OR: 11.55, 95% CI: 1.32-100.92, p = 0.027; OR: 8.17, CI: 1.61-41.46, p = 0.011, respectively).
  
  
  CONCLUSIONS
  The use of dual antiplatelet drugs and a higher aPTT can lead to an increased risk of post-procedural vascular complications. Therefore, manual compression should be applied cautiously after the correction of coagulopathy factors such as activated clotting time (ACT), aPTT, and platelets.
authors.affiliation: Department of Pulmonology and Critical Care Medicine, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Yangsan-si, Republic of Korea.
authors.forename: Hye Ju
authors.initials: HJ
authors.lastname: Yeo
authors.affiliation: Department of Internal Medicine, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Yangsan-si, Republic of Korea.
authors.forename: Hyeong Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Yangsan-si, Republic of Korea.
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Yangsan-si, Republic of Korea.
authors.forename: Lae Hyung
authors.initials: LH
authors.lastname: Kang
authors.affiliation: Department of Pulmonology and Critical Care Medicine, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Yangsan-si, Republic of Korea.
authors.forename: Woo Hyun
authors.initials: WH
authors.lastname: Cho
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea.
authors.forename: Dohyung
authors.initials: D
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects*; D020878:Device Removal / Q000009:adverse effects*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005263:Femoral Artery; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure / Q000009:adverse effects*; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery