Meta-Analysis of Peripheral or Central Extracorporeal Membrane Oxygenation in Postcardiotomy and Non-Postcardiotomy Shock

Giuseppe Maria Raffa, Mariusz Kowalewski, Daniel Brodie, Mark Ogino, Glenn Whitman, Paolo Meani, Michele Pilato, Antonio Arcadipane, Thijs Delnoij, Eshan Natour, Sandro Gelsomino, Jos Maessen, Roberto Lorusso

Research output: Contribution to journalReview article

Abstract

Background: Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) application in postcardiotomy shock (PCS) and non-PCS is increasing. VA-ECMO plays a critical role in the management of these patients, yet may be associated with serious complications. Methods: A systematic review of all available reports in the literature of patients receiving VA-ECMO, either directly or indirectly, comparing central cannulation (right atrial to ascending aorta) versus peripheral cannulation (femoral vein to femoral artery or axillary artery) were analyzed. The primary endpoint was survival. Cerebrovascular events, limb complications, bleeding requiring reoperation, sepsis, continuous venovenous hemofiltration, and transfusions were also assessed in both groups. Results: Seventeen retrospective case series clearly describing the VA-ECMO access and including 1,691 patients with PCS and non-PCS were found. The peripheral approach was more commonly used (980 patients, 57.9%) than the central one. There was no difference in the analysis between the two techniques regarding all-cause mortality risk ratio (1.00, 95% confidence interval: 0.94 to 1.08, I2 = 0%, p = 0.92). No statistical differences were found between peripheral and central VA-ECMO with regard to cerebrovascular events, limb complications, or sepsis rates. Peripheral cannulation was associated with a significant reduction in the risk of bleeding (p = 0.02), continuous venovenous hemofiltration (p = 0.03), transfusion of red blood cells units (p < 0.00001), fresh frozen plasma units (p = 0.0002), and platelets units (p < 0.00001). Conclusions: Peripheral and central VA-ECMO configurations showed comparable inhospital survival for PCS and non-PCS. The risk of bleeding, continuous venovenous hemofiltration, and blood product transfusion was significantly lower with the peripheral cannulation strategy.

Original languageEnglish
Pages (from-to)311-321
Number of pages11
JournalAnnals of Thoracic Surgery
Volume107
Issue number1
DOIs
Publication statusE-pub ahead of print - Jun 28 2018

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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