PMID- 30430207 OWN - NLM STAT- MEDLINE DCOM- 20191101 LR - 20191101 IS - 1432-1238 (Electronic) IS - 0342-4642 (Linking) VI - 44 IP - 12 DP - 2018 Dec TI - Percutaneous versus surgical femoro-femoral veno-arterial ECMO: a propensity score matched study. PG - 2153-2161 LID - 10.1007/s00134-018-5442-z [doi] AB - PURPOSE: Femoral artery surgical cannulation is the reference for venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adults. However, the less invasive percutaneous approach has been associated with lower rates of complications. This retrospective study compared complication rates and overall survival in a large series of patients who received surgical or percutaneous peripheral VA-ECMO. METHODS: All consecutive patients implanted with VA-ECMO between January 2015 and December 2017 in a high ECMO-volume university hospital were included. Surgical cannulation was the only approach until late 2016 after which the percutaneous approach became the first line strategy. Propensity score framework analyzes were used to compare outcomes of percutaneous and surgical groups while controlling for confounders. RESULTS: Among the 814 patients who received VA-ECMO (485 surgical and 329 percutaneous), propensity-score matching selected 266 unique pairs of patients with similar characteristics. Percutaneous cannulation was associated with fewer local infections (16.5% versus 27.8%, p = 0.001), similar rates of limb ischemia (8.6% versus 12.4%, p = 0.347) and sensory-motor complications (2.6% versus 2.3%, p = 0.779) and improved 30-day survival (63.8% versus 56.3%, p = 0.034). However, more vascular complications following decannulation (14.7% versus 3.4%, p < 0.001), mainly persistent bleeding requiring surgical revision (9.4% vs. 1.5%, p < 0.001), occurred after percutaneous cannulation. CONCLUSIONS: Compared to the surgical approach, percutaneous cannulation for peripheral VA-ECMO was associated with fewer local infections, similar rates of ischemia and sensory-motor complications and improved 30-day survival. The higher rate of vascular complications following decannulation suggests that improvements in cannula removal techniques are needed to further improve patients' outcomes after percutaneous cannulation. FAU - Danial, Pichoy AU - Danial P AD - Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitie-Salpetriere Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l'hopital, Paris, 75013, France. FAU - Hajage, David AU - Hajage D AD - Sorbonne Universite, AP-HP, Hopital Pitie-Salpetriere, Departement Biostatistique Sante Publique Et Information Medicale, Unite de Recherche Clinique PSL-CFX, Centre de Pharmacoepidemiologie (Cephepi), CIC-1421, Paris, France. FAU - Nguyen, Lee S AU - Nguyen LS AD - Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitie-Salpetriere Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l'hopital, Paris, 75013, France. FAU - Mastroianni, Ciro AU - Mastroianni C AD - Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitie-Salpetriere Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l'hopital, Paris, 75013, France. FAU - Demondion, Pierre AU - Demondion P AD - Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitie-Salpetriere Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l'hopital, Paris, 75013, France. FAU - Schmidt, Matthieu AU - Schmidt M AD - Medical Intensive Care Unit, Institute of Cardiology, Pitie-Salpetriere Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Sorbonne Universite, Paris, France. FAU - Bougle, Adrien AU - Bougle A AD - Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitie-Salpetriere Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Sorbonne Universite, Paris, France. FAU - Amour, Julien AU - Amour J AD - Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitie-Salpetriere Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Sorbonne Universite, Paris, France. FAU - Leprince, Pascal AU - Leprince P AD - Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitie-Salpetriere Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l'hopital, Paris, 75013, France. FAU - Combes, Alain AU - Combes A AD - Medical Intensive Care Unit, Institute of Cardiology, Pitie-Salpetriere Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Sorbonne Universite, Paris, France. FAU - Lebreton, Guillaume AU - Lebreton G AD - Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitie-Salpetriere Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l'hopital, Paris, 75013, France. guillaume.lebreton@aphp.fr. LA - eng PT - Comparative Study PT - Journal Article DEP - 20181114 PL - United States TA - Intensive Care Med JT - Intensive care medicine JID - 7704851 SB - IM CIN - Intensive Care Med. 2019 Apr;45(4):559-560. PMID: 30840116 MH - Adult MH - Aged MH - Catheterization, Peripheral/*adverse effects/*methods MH - Extracorporeal Membrane Oxygenation/adverse effects/*methods MH - Female MH - Femoral Artery/*surgery MH - Femoral Vein/*surgery MH - Humans MH - Male MH - Middle Aged MH - Postoperative Complications/*epidemiology MH - Propensity Score MH - Retrospective Studies MH - Survival Rate OTO - NOTNLM OT - Adverse events OT - ECLS OT - ECMO OT - Percutaneous cannulation OT - Surgical cannulation EDAT- 2018/11/16 06:00 MHDA- 2019/11/02 06:00 CRDT- 2018/11/16 06:00 PHST- 2018/07/06 00:00 [received] PHST- 2018/10/31 00:00 [accepted] PHST- 2018/11/16 06:00 [pubmed] PHST- 2019/11/02 06:00 [medline] PHST- 2018/11/16 06:00 [entrez] AID - 10.1007/s00134-018-5442-z [pii] AID - 10.1007/s00134-018-5442-z [doi] PST - ppublish SO - Intensive Care Med. 2018 Dec;44(12):2153-2161. doi: 10.1007/s00134-018-5442-z. Epub 2018 Nov 14.