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Vale JD, Kantor E, Papin G, Sonneville R, Braham W, Para M, Montravers P, Longrois D, Provenchère S. Femoro-axillary versus femoro-femoral veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock: A monocentric retrospective study. Perfusion 2024:2676591241261330. [PMID: 38867368 DOI: 10.1177/02676591241261330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
RATIONALE For veno-arterial extracorporeal membrane oxygenation (ECMO), the femoral artery is the preferred cannulation site (femoro-femoral: Vf-Af). This results in retrograde aortic flow, which increases the left ventricular afterload and can lead to severe pulmonary edema and thrombosis of the cardiac chambers. Right axillary artery cannulation (femoral-axillary: Vf-Aa) provides partial anterograde aortic flow, which may prevent some complications. This study aimed to compare the 90-day mortality and complication rates between VF-AA and VF-AF. METHODS Consecutive adult patients with cardiogenic shock who received peripheral VA-ECMO between 2013 and 2019 at our institution were retrospectively included. The exclusion criteria were refractory cardiac arrest, multiple VA-ECMO implantations due to vascular access changes, weaning failure, or ICU readmission. A statistical approach using inverse probability of treatment weighting was used to estimate the effect of the cannulation site on the outcomes. The primary endpoint was the 90-day mortality. The secondary endpoints were vascular access complications, stroke, and other complications related to retrograde blood flow. Outcomes were estimated using logistic regression analysis. RESULTS VA-ECMO was performed on 534 patients. Patients with refractory cardiac arrest (n = 77 (14%)) and those supported by multiple VA-ECMO (n = 92, (17%)) were excluded. Out of the 333 patients studied (n = 209 Vf-Aa; n = 124 VF-AF), the main indications for VA-ECMO implantation were post-cardiotomy (33%, n = 109), dilated cardiomyopathy (20%, n = 66), post-cardiac transplantation (15%, n = 50), acute myocardial infarction (14%, n = 46) and other etiologies (18%, n = 62). The median SOFA score was 9 [7-11], and the crude 90-day mortality rate was 53% (n = 175). After IPTW, the 90-day mortality was similar in the Vf-Aa and VF-AF groups (54% vs 58%, IPTW-OR = 0.84 [0.54-1.29]). Axillary artery cannulation was associated with significantly fewer local infections (OR = 0.21, 95% CI:0.09-0.51), limb ischemia (OR = 0.37, 95% CI:0.17-0.84), bowel ischemia (OR = 0.16, 95% CI:0.05-0.51) and pulmonary edema (OR = 0.52, 95% CI:0.29-0.92) episodes, but with a higher rate of stroke (OR = 2.87, 95% CI:1.08-7.62) than femoral artery cannulation. CONCLUSION Compared to VF-AF, axillary cannulation was associated with similar 90-day mortality rates. The high rate of stroke associated with axillary artery cannulation requires further investigation.
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Affiliation(s)
- Julien Do Vale
- Anesthesiology and Surgical Critical Care Department, DMU PARABOL, AP-HP, Bichat Hospital, Paris, France
| | - Elie Kantor
- Anesthesiology and Surgical Critical Care Department, DMU PARABOL, AP-HP, Bichat Hospital, Paris, France
| | - Grégory Papin
- Anesthesiology and Surgical Critical Care Department, DMU PARABOL, AP-HP, Bichat Hospital, Paris, France
| | - Romain Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, AP-HP, Bichat Hospital, Paris, France
- UMR1148, LVTS, Sorbonne Paris Cité, Paris, France
| | - Wael Braham
- Assistance Publique Des Hopitaux de Paris, Bichat Hospital, Service de Chirurgie Cardiaque, Paris Diderot University, Sorbonne Paris Cité, INSERM/Paris Diderot University, Paris, France
| | - Marylou Para
- Assistance Publique Des Hopitaux de Paris, Bichat Hospital, Service de Chirurgie Cardiaque, Paris Diderot University, Sorbonne Paris Cité, INSERM/Paris Diderot University, Paris, France
| | - Philippe Montravers
- Anesthesiology and Surgical Critical Care Department, DMU PARABOL, AP-HP, Bichat Hospital, Paris, France
- INSERM Unit U1152, Université de Paris, Paris, France
| | - Dan Longrois
- Anesthesiology and Surgical Critical Care Department, DMU PARABOL, AP-HP, Bichat Hospital, Paris, France
- INSERM Unit U1148, Université de Paris, Paris, France
| | - Sophie Provenchère
- Anesthesiology and Surgical Critical Care Department, DMU PARABOL, AP-HP, Bichat Hospital, Paris, France
- INSERM CIC-EC 1425, AP-HP, Bichat Hospital, Paris, France
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Andrei S, Nguyen M, Berthoud V, Durand B, Duclos V, Morgant MC, Bouchot O, Bouhemad B, Guinot PG. Determinants of Arterial Pressure of Oxygen and Carbon Dioxide in Patients Supported by Veno-Arterial ECMO. J Clin Med 2022; 11:jcm11175228. [PMID: 36079158 PMCID: PMC9457238 DOI: 10.3390/jcm11175228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 12/14/2022] Open
Abstract
Background: The present study aimed to assess the determinants of arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2) in the early phase of veno-arterial extracorporeal membrane oxygenation (VA ECMO) support. Even though the guidelines considered both the risks of hypoxemia and hyperoxemia during ECMO support, there are a lack of data concerning the patients supported by VA ECMO. Methods: This is a retrospective, monocentric, observational cohort study in a university-affiliated cardiac intensive care unit. Hemodynamic parameters, ECMO parameters, ventilator settings, and blood gas analyses were collected at several time points during the first 48 h of VA ECMO support. For each timepoint, the blood samples were drawn simultaneously from the right radial artery catheter, VA ECMO venous line (before the oxygenator), and from VA ECMO arterial line (after the oxygenator). Univariate followed by multivariate mixed-model analyses were performed for longitudinal data analyses. Results: Forty-five patients with femoro-femoral peripheral VA ECMO were included. In multivariate analysis, the patients' PaO2 was independently associated with QEC, FDO2, and time of measurement. The patients' PaCO2 was associated with the sweep rate flow and the PpreCO2. Conclusions: During acute VA ECMO support, the main determinants of patient oxygenation are determined by VA ECMO parameters.
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Affiliation(s)
- Stefan Andrei
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, F-21000 Dijon, France
- Department of Anaesthesiology and Critical Care Medicine, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
- Correspondence: ; Tel.: +33-38-029-3031
| | - Maxime Nguyen
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, F-21000 Dijon, France
- LNC UMR1231, University of Burgundy and Franche-Comté, F-21000 Dijon, France
| | - Vivien Berthoud
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, F-21000 Dijon, France
| | - Bastian Durand
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, F-21000 Dijon, France
| | - Valerian Duclos
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, F-21000 Dijon, France
| | | | - Olivier Bouchot
- Cardiac Surgery Department, Dijon University Hospital, F-21000 Dijon, France
| | - Belaid Bouhemad
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, F-21000 Dijon, France
- LNC UMR1231, University of Burgundy and Franche-Comté, F-21000 Dijon, France
| | - Pierre-Grégoire Guinot
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, F-21000 Dijon, France
- LNC UMR1231, University of Burgundy and Franche-Comté, F-21000 Dijon, France
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Cavayas YA, Noly PE, Singh G, Lamarche Y. Controversies in extracorporeal membrane oxygenation: Immediate versus watchful waiting for venoarterial extracorporeal membrane oxygenation venting. JTCVS OPEN 2021; 8:70-76. [PMID: 36004177 PMCID: PMC9390622 DOI: 10.1016/j.xjon.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022]
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Pellenc Q, Girault A, Roussel A, Aguir S, Cerceau P, Longrois D, Mal H, Mordant P, Castier Y. Preclosing of the femoral artery allows total percutaneous venoarterial extracorporeal membrane oxygenation and prevents groin wound infection after lung transplantation. Eur J Cardiothorac Surg 2021; 58:371-378. [PMID: 32083665 DOI: 10.1093/ejcts/ezaa039] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/14/2020] [Accepted: 01/17/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES In lung transplantation (LT), femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) usually requires an open approach that may be associated with severe groin wound infection. In endovascular aortic procedures, preclosing of the femoral artery (PFA) with vascular closure devices allows the percutaneous insertion and withdrawal of large-bore cannulae. We sought to evaluate whether this innovative technique could be applied in the specific setting of LT to achieve total percutaneous VA-ECMO and decrease groin wound infection. METHODS We conducted a retrospective study of a prospective database including patients who underwent LT in our centre from January 2011 to December 2017. Patients who underwent peripheral VA-ECMO using the PFA technique after January 2014 (PFA group, n = 106) were compared to those who underwent peripheral VA-ECMO using open cannulation and/or decannulation before January 2014 (non-PFA group, n = 48). The primary end point was the rate of technical success defined as total percutaneous VA-ECMO. Secondary end points included groin wound infections and delayed vascular complications. RESULTS The PFA technique was technically successful in 98 patients (92.5%). As compared with the non-PFA group, the PFA group was characterized by a similar rate of vascular complications (16.6% vs 11.3%, P = 0.360) and a decreased rate of groin wound infection (18.9% vs 0%, P < 0.001). In multivariate analysis, risk factors associated with vascular complications following PFA included female sex, peripheral arterial disease and ECMO duration. CONCLUSIONS In LT patients, PFA is associated with a high rate of total percutaneous VA-ECMO, thus preventing the occurrence of groin wound infection.
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Affiliation(s)
- Quentin Pellenc
- Service de Chirurgie Vasculaire, Thoracique, et Transplantation Pulmonaire, Bichat Hospital, Paris University, Paris, France
| | - Antoine Girault
- Service de Chirurgie Vasculaire, Thoracique, et Transplantation Pulmonaire, Bichat Hospital, Paris University, Paris, France
| | - Arnaud Roussel
- Service de Chirurgie Vasculaire, Thoracique, et Transplantation Pulmonaire, Bichat Hospital, Paris University, Paris, France
| | - Sonia Aguir
- Service de Chirurgie Vasculaire, Thoracique, et Transplantation Pulmonaire, Bichat Hospital, Paris University, Paris, France
| | - Pierre Cerceau
- Service de Chirurgie Vasculaire, Thoracique, et Transplantation Pulmonaire, Bichat Hospital, Paris University, Paris, France
| | - Dan Longrois
- Département d'Anesthésie-Réanimation, Bichat Hospital, Paris University, Paris, France
| | - Hervé Mal
- Service de Pneumologie B et Transplantation Pulmonaire, Bichat Hospital, Paris University, Paris, France
| | - Pierre Mordant
- Service de Chirurgie Vasculaire, Thoracique, et Transplantation Pulmonaire, Bichat Hospital, Paris University, Paris, France
| | - Yves Castier
- Service de Chirurgie Vasculaire, Thoracique, et Transplantation Pulmonaire, Bichat Hospital, Paris University, Paris, France
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Pisani A, Braham W, Brega C, Lajmi M, Provenchere S, Danial P, Alkhoder S, Para M, Ghodbane W, Nataf P. Right axillary artery cannulation for venoarterial extracorporeal membrane oxygenation: a retrospective single centre observational study. Eur J Cardiothorac Surg 2020; 59:601-609. [DOI: 10.1093/ejcts/ezaa397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
Our goal was to assess the safety, outcomes and complication rate of axillary artery cannulation for venoarterial extracorporeal membrane oxygenation (VA-ECMO).
METHODS
A retrospective analysis was conducted on data obtained from the review of medical charts of all consecutive patients undergoing VA-ECMO implantation between January 2013 and December 2017 at a teaching hospital. Only patients with right axillary VA-ECMO implantation in a non-emergency setting were included. Post-procedural outcomes and local and systemic complications were analysed.
RESULTS
One hundred and seventy-four [131 male (75.3%), 43 female (24.7%); mean age 56.8 ± 15.1 years] patients underwent femoral-axillary VA-ECMO. Indications were cardiogenic shock from any cause (n = 78, 44.8%) or post-cardiotomy syndrome (n = 96, 55.2%). Fifty-three (30.5%) patients died while on VA-ECMO support. At the time of VA-ECMO ablation, 89 (51.1%) patients had recovered; 13 (7.5%) patients were bridged to a long-term mechanical support device and 19 (10.9%) patients underwent heart transplants. Thirty-day and 1-year mortality was 36.2% (n = 63) and 49.4% (n = 86), respectively. The 1-year survival rate of patients who were weaned from VA-ECMO support was 72.7% (n = 88). The complications of axillary cannulation were bleeding (n = 7, 4%), local infection (n = 3, 1.7%), upper limb ischaemia (n = 2, 1.1%) and brachial plexus injury (n = 1, 0.6%). Left ventricle unloading was required for 9 (5.2%) patients. The median duration of VA-ECMO support was 7 (range 1–26) days.
CONCLUSIONS
Right axillary artery cannulation is a safe and reliable method for VA-ECMO support with a low rate of local complications. In the absence of a control group with femoro-femoral cannulation, no definitive conclusion about the superiority of axillary over femoral cannulation can be drawn.
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Affiliation(s)
- Angelo Pisani
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Wael Braham
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Carlotta Brega
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Moklhes Lajmi
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Sophie Provenchere
- Department of Anesthesia, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
- Université de Paris, Centre d'Investigation Clinique 1425, INSERM, Paris, France
| | - Pichoy Danial
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Soleiman Alkhoder
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Marylou Para
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
- Université de Paris, LVTS UMRS 1148, INSERM, Paris, France
| | - Walid Ghodbane
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Patrick Nataf
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
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Hoyler MM, Flynn B, Iannacone EM, Jones MM, Ivascu NS. Clinical Management of Venoarterial Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2020; 34:2776-2792. [DOI: 10.1053/j.jvca.2019.12.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/04/2019] [Accepted: 12/29/2019] [Indexed: 12/13/2022]
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Malchesky PS. Artificial Organs
2019: A year in review. Artif Organs 2020; 44:314-338. [DOI: 10.1111/aor.13650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 12/13/2022]
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