PMID- 34977748
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220429
IS  - 2666-2507 (Electronic)
IS  - 2666-2507 (Linking)
VI  - 10
DP  - 2021 Dec
TI  - Preclosure technique versus arterial cutdown after percutaneous cannulation for 
      venoarterial extracorporeal membrane oxygenation.
PG  - 322-330
LID - 10.1016/j.xjtc.2021.08.030 [doi]
AB  - BACKGROUND: Arteriotomy repair through the preclosure technique during elective 
      arterial access procedures is well documented. Outcomes associated with 
      application of this technique to the removal of arterial access cannulas in 
      patients undergoing urgent venoarterial extracorporeal membrane oxygenation 
      (VA-ECMO) have not previously been reported. METHODS: We reviewed the records of 
      consecutive patients who required VA-ECMO for cardiogenic shock. Patients were 
      compared by use of the preclosure device (Perclose ProGlide Suture-Mediated 
      Closure System; Abbott Vascular, Abbott Park, Ill) at time of VA-ECMO 
      cannulation. The rate of limb complications (composite of limb ischemia, 
      infection, and site necrosis) and secondary end points of bleeding events, 
      pseudoaneurysm, distal part embolization, and intensive care unit length of stay 
      after decannulation were compared between the groups. RESULTS: Ninety-nine 
      consecutive patients managed with VA-ECMO were identified and the preclosure 
      device was utilized in 51 of these patients. Preclosure device failure occurred 
      in 5 instances (9.8%) and was successfully managed with surgical repair in 4 
      cases and endovascular intervention in another. Use of the preclosure device was 
      associated with both fewer limb complications (odds ratio, 0.19; 95% confidence 
      interval, 0.03-0.78) and bleeding events (odds ratio, 0.21; 95% confidence 
      interval, 0.04-0.89). Pseudoaneurysm (n = 0) and distal part embolization (n = 1) 
      were infrequently encountered in the cohort and no difference in intensive care 
      unit length of stay after decannulation was noted between the groups. 
      CONCLUSIONS: In this cohort, use of the preclosure technique in weaning from 
      VA-ECMO was technically feasible, safe, and associated with an approximate 80% 
      lower likelihood of limb complications and bleeding events compared with surgical 
      removal.
FAU - Chandel, Abhimanyu
AU  - Chandel A
AD  - Department of Pulmonary and Critical Care, Walter Reed National Military Medical 
      Center, Bethesda, Md.
FAU - Desai, Mehul
AU  - Desai M
AD  - Department of Critical Care, Pulmonary, Allergy, and Immunology, Inova Health 
      System, Fairfax, Va.
FAU - Ryan, Liam P
AU  - Ryan LP
AD  - Department of Cardiac Surgery, Inova Heart and Vascular Institute, Fairfax, Va.
FAU - Clevenger, Lindsay
AU  - Clevenger L
AD  - Department of Critical Care, Pulmonary, Allergy, and Immunology, Inova Health 
      System, Fairfax, Va.
FAU - Speir, Alan M
AU  - Speir AM
AD  - Department of Cardiac Surgery, Inova Heart and Vascular Institute, Fairfax, Va.
FAU - Singh, Ramesh
AU  - Singh R
AD  - Department of Cardiac Surgery, Inova Heart and Vascular Institute, Fairfax, Va.
LA  - eng
PT  - Journal Article
DEP - 20210826
PL  - United States
TA  - JTCVS Tech
JT  - JTCVS techniques
JID - 101768546
PMC - PMC8691737
OTO - NOTNLM
OT  - ICU, intensive care unit
OT  - VA-ECMO, venoarterial extracorporeal membrane oxygenation
OT  - arterial complications
OT  - arteriotomy repair
OT  - cardiogenic shock
OT  - extracorporeal membrane oxygenation
OT  - percutaneous arterial closure
EDAT- 2022/01/04 06:00
MHDA- 2022/01/04 06:01
PMCR- 2021/08/26
CRDT- 2022/01/03 05:55
PHST- 2021/03/11 00:00 [received]
PHST- 2021/08/17 00:00 [accepted]
PHST- 2022/01/03 05:55 [entrez]
PHST- 2022/01/04 06:00 [pubmed]
PHST- 2022/01/04 06:01 [medline]
PHST- 2021/08/26 00:00 [pmc-release]
AID - S2666-2507(21)00589-7 [pii]
AID - 10.1016/j.xjtc.2021.08.030 [doi]
PST - epublish
SO  - JTCVS Tech. 2021 Aug 26;10:322-330. doi: 10.1016/j.xjtc.2021.08.030. eCollection 
      2021 Dec.