Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation

Hiroo Takayama, Elissa Landes, Lauren Truby, Kevin Fujita, Ajay J. Kirtane, Linda Mongero, Melana Yuzefpolskaya, Paolo C. Colombo, Ulrich P. Jorde, Paul A. Kurlansky, Koji Takeda, Yoshifumi Naka

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objectives To facilitate venoarterial extracorporeal membrane oxygenation (ECMO) insertion for cardiogenic shock, we recently adopted a strategy of using a 15F arterial cannula in all patients, rather than 1 designed to maximize flow. We aimed to compare the clinical outcomes of these 2 strategies. Methods In this retrospective study, 101 consecutive patients supported with ECMO via femoral cannulation between March 2007 and March 2013 were divided into 2 groups: Group L (17F-24F arterial cannula to accommodate full flow [ie, cardiac index of 2.5 L/m<sup>2</sup>/min]; n = 51) and Group S (15F arterial cannula; n = 50). The primary outcomes of interest were patients' overall status at 24 hours of support and cannulation-related adverse events. Results There were no significant differences in patient demographics, etiology of cardiogenic shock, or severity of illness before ECMO initiation between the 2 groups. Group L had significantly higher ECMO flow than Group S (flow index at 24 hours: 2.2 ± 0.7 vs 1.7 ± 0.3 L/m<sup>2</sup>/min; P < .001). However, there was no significant difference in use of vasoactive medication/hemodynamic parameters/laboratory parameters. Group L had higher incidence of cannulation-related adverse events (35% vs 22% in Group S [P = .14]), particularly in cannulation site bleeding (28% vs 10% [P = .03]). Thirty-day survival was 55% in Group L versus 52% in Group S (P = .77). Bleeding complication occurred in 53% in Group L versus 32% in Group S (P = .03). Conclusions Compared with the use of larger cannulas, ECMO with a 15F arterial cannula appears to provide comparable clinical support with reduced bleeding complications.

Original languageEnglish (US)
Article number9339
Pages (from-to)1428-1433
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume149
Issue number5
DOIs
StatePublished - May 1 2015
Externally publishedYes

Fingerprint

Extracorporeal Membrane Oxygenation
Catheterization
Cardiogenic Shock
Hemorrhage
Thigh
Retrospective Studies
Hemodynamics
Demography
Cannula
Survival
Incidence

Keywords

  • cardiogenic shock
  • complications
  • ECMO

ASJC Scopus subject areas

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

Cite this

Takayama, H., Landes, E., Truby, L., Fujita, K., Kirtane, A. J., Mongero, L., ... Naka, Y. (2015). Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation. Journal of Thoracic and Cardiovascular Surgery, 149(5), 1428-1433. [9339]. https://doi.org/10.1016/j.jtcvs.2015.01.042

Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation. / Takayama, Hiroo; Landes, Elissa; Truby, Lauren; Fujita, Kevin; Kirtane, Ajay J.; Mongero, Linda; Yuzefpolskaya, Melana; Colombo, Paolo C.; Jorde, Ulrich P.; Kurlansky, Paul A.; Takeda, Koji; Naka, Yoshifumi.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 149, No. 5, 9339, 01.05.2015, p. 1428-1433.

Research output: Contribution to journalArticle

Takayama, H, Landes, E, Truby, L, Fujita, K, Kirtane, AJ, Mongero, L, Yuzefpolskaya, M, Colombo, PC, Jorde, UP, Kurlansky, PA, Takeda, K & Naka, Y 2015, 'Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation', Journal of Thoracic and Cardiovascular Surgery, vol. 149, no. 5, 9339, pp. 1428-1433. https://doi.org/10.1016/j.jtcvs.2015.01.042
Takayama, Hiroo ; Landes, Elissa ; Truby, Lauren ; Fujita, Kevin ; Kirtane, Ajay J. ; Mongero, Linda ; Yuzefpolskaya, Melana ; Colombo, Paolo C. ; Jorde, Ulrich P. ; Kurlansky, Paul A. ; Takeda, Koji ; Naka, Yoshifumi. / Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation. In: Journal of Thoracic and Cardiovascular Surgery. 2015 ; Vol. 149, No. 5. pp. 1428-1433.
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abstract = "Objectives To facilitate venoarterial extracorporeal membrane oxygenation (ECMO) insertion for cardiogenic shock, we recently adopted a strategy of using a 15F arterial cannula in all patients, rather than 1 designed to maximize flow. We aimed to compare the clinical outcomes of these 2 strategies. Methods In this retrospective study, 101 consecutive patients supported with ECMO via femoral cannulation between March 2007 and March 2013 were divided into 2 groups: Group L (17F-24F arterial cannula to accommodate full flow [ie, cardiac index of 2.5 L/m2/min]; n = 51) and Group S (15F arterial cannula; n = 50). The primary outcomes of interest were patients' overall status at 24 hours of support and cannulation-related adverse events. Results There were no significant differences in patient demographics, etiology of cardiogenic shock, or severity of illness before ECMO initiation between the 2 groups. Group L had significantly higher ECMO flow than Group S (flow index at 24 hours: 2.2 ± 0.7 vs 1.7 ± 0.3 L/m2/min; P < .001). However, there was no significant difference in use of vasoactive medication/hemodynamic parameters/laboratory parameters. Group L had higher incidence of cannulation-related adverse events (35{\%} vs 22{\%} in Group S [P = .14]), particularly in cannulation site bleeding (28{\%} vs 10{\%} [P = .03]). Thirty-day survival was 55{\%} in Group L versus 52{\%} in Group S (P = .77). Bleeding complication occurred in 53{\%} in Group L versus 32{\%} in Group S (P = .03). Conclusions Compared with the use of larger cannulas, ECMO with a 15F arterial cannula appears to provide comparable clinical support with reduced bleeding complications.",
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AU - Kirtane, Ajay J.

AU - Mongero, Linda

AU - Yuzefpolskaya, Melana

AU - Colombo, Paolo C.

AU - Jorde, Ulrich P.

AU - Kurlansky, Paul A.

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N2 - Objectives To facilitate venoarterial extracorporeal membrane oxygenation (ECMO) insertion for cardiogenic shock, we recently adopted a strategy of using a 15F arterial cannula in all patients, rather than 1 designed to maximize flow. We aimed to compare the clinical outcomes of these 2 strategies. Methods In this retrospective study, 101 consecutive patients supported with ECMO via femoral cannulation between March 2007 and March 2013 were divided into 2 groups: Group L (17F-24F arterial cannula to accommodate full flow [ie, cardiac index of 2.5 L/m2/min]; n = 51) and Group S (15F arterial cannula; n = 50). The primary outcomes of interest were patients' overall status at 24 hours of support and cannulation-related adverse events. Results There were no significant differences in patient demographics, etiology of cardiogenic shock, or severity of illness before ECMO initiation between the 2 groups. Group L had significantly higher ECMO flow than Group S (flow index at 24 hours: 2.2 ± 0.7 vs 1.7 ± 0.3 L/m2/min; P < .001). However, there was no significant difference in use of vasoactive medication/hemodynamic parameters/laboratory parameters. Group L had higher incidence of cannulation-related adverse events (35% vs 22% in Group S [P = .14]), particularly in cannulation site bleeding (28% vs 10% [P = .03]). Thirty-day survival was 55% in Group L versus 52% in Group S (P = .77). Bleeding complication occurred in 53% in Group L versus 32% in Group S (P = .03). Conclusions Compared with the use of larger cannulas, ECMO with a 15F arterial cannula appears to provide comparable clinical support with reduced bleeding complications.

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