Subclavian versus femoral arterial cannulations during extracorporeal membrane oxygenation: A propensity-matched comparison.

Autor:	Moussa MD; CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France. Electronic address: mouhamed.moussa@chru-lille.fr., Rousse N; University Lille, CHU Lille, Cardiac Surgery, Lille, France., Abou Arab O; Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, CURS, Jules Verne University of Picardie, Amiens, France., Lamer A; CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France; University Lille, INSERM, CHU Lille, Lille, France; University Lille, CHU Lille, Évaluation des technologies de santé et des pratiques médicales, Lille, France., Gantois G; CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France., Soquet J; University Lille, CHU Lille, Cardiac Surgery, Lille, France., Liu V; CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France., Mugnier A; University Lille, CHU Lille, Cardiac Surgery, Lille, France., Duburcq T; CHU Lille, Pôle des Réanimations, Lille, France., Petitgand V; CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France., Foulon V; CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France., Dumontet J; CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France., Deblauwe D; CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France., Juthier F; University Lille, CHU Lille, Cardiac Surgery, Lille, France., Desbordes J; CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France., Loobuyck V; University Lille, CHU Lille, Cardiac Surgery, Lille, France., Labreuche J; University Lille, CHU Lille, Évaluation des technologies de santé et des pratiques médicales, Lille, France; CHU Lille, Department of Biostatistics, Lille, France., Robin E; CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France., Vincentelli A; University Lille, CHU Lille, Cardiac Surgery, Lille, France.
Jazyk:	angličtina
Zdroj:	The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2022 May; Vol. 41 (5), pp. 608-618. Date of Electronic Publication: 2022 Jan 10.
DOI:	10.1016/j.healun.2022.01.007
Abstrakt:	Background: During peripheral extracorporeal veno-arterial membrane oxygenation (VA-ECMO) support, subclavian arterial cannulation provides, in comparison to femoral arterial cannulation, an anterograde flow which may prevent from left ventricular (LV) distention and improve outcomes. We aimed to compare the effectiveness of subclavian cannulation to femoral cannulation in reducing LV overdistension consequences, hemostatic complications and mortality. Methods: This retrospective study conducted in two intensive care units of the Lille academic hospitals from January 2013 to December 2019 included 372 non-moribund adult patients supported by VA-ECMO. The primary endpoint was a new onset of pulmonary edema (PO) or LV unloading. Secondary endpoints were myocardial recovery, serious bleeding (according to Extracorporeal Life Support Organization definition), thrombotic complications (a composite of stroke, cannulated limb or mesenteric ischemia, intracardiac or aortic-root thrombosis) and 28 day mortality. Differences in outcomes were analyzed using propensity score matching (PSM) and inverse probability of treatment weighting adjustment (IPTW). Results: As compared to femoral cannulation (n = 320 patients), subclavian cannulation (n = 52 patients) did not reduce the occurrence of new onset of PO or LV unloading after PSM [HR 0.99 (95% CI 0.51-1.91)]. There was no other difference in outcomes in PSM cohort. In IPTW adjustment cohort, subclavian cannulation was associated with reduced recovery and increased serious bleeding with four accidental decannulations observed. Conclusion: Subclavian artery cannulation was not associated with reduced LV distension related complications, thrombotic complications and 28 day mortality. Rather, it may increase serious bleeding and accidental decannulations, and reduce recovery. Therefore, subclavian cannulation should be limited to vascular accessibility issues. Competing Interests: Disclosure statement The authors declare no conflict of interest. Institutional and departmental sources. (Copyright © 2022 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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