The Effect of Different Cannulation Strategies for Extracorporeal Membrane Oxygenation Support in Postcardiotomy Patients

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) application in postcardiotomy shock is increasing. Little is known about the effect of different cannulation strategies on morbidity, weaning success and survival. Therefore, we investigated clinical outcomes of patients supported by centrally and peripheral instituted VA-ECMO after cardiac surgery.

Methods: In our database, 274 patients could be identified who were supported with VA-ECMO after cardiac surgery. The cannulation strategies consisted of peripheral (femoral, axillary) cannulation (174 patients) or central cannulation, either performed directly (48 patients) or through a subxiphoidally directed prosthesis connected with the ascending aorta (52 patients).

Results: Demographic and operative data of the different groups were comparable. The duration of ECMO support did not differ significantly. Central cannulation was associated with a significantly lower stroke rate (p = 0.017) but also with a significantly higher rate of pericardial tamponade (p = 0.001) if performed via a prosthesis. Weaning rates and short time survival did not differ between the groups.

Conclusion: Peripheral and central VA-ECMO configurations showed comparable weaning and survival rates. The rate of adverse events was comparable too, but central cannulation is associated with a significantly lower stroke rate.

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