Incidence of Acute Vascular Complications after ECMO Implantation: Percutaneous versus Surgical Access

Objectives: Extracorporeal membrane oxygenation (ECMO) is often the only acutely available lifesaving treatment option for patients with end-stage respiratory or circulatory failure. At our tertiary center, we perform up to 120 ECMO implants annually, with increasing numbers over the past years and also provide national ECMO transports. While initially cannulation was performed by surgical cut down, now the preferred approach is percutaneous. With this study, we aim to analyze the incidence of vascular complications depending on the vascular access.

Methods: Between January 1, 2007, and December 31, 2017, a total of 790 patients received an ECMO at our center. Preoperative, intraoperative, and in-hospital data were collected from the medical records. Type of ECMO cannulation, acute vascular complications, and survival were evaluated.

Results: Median age was 37 years (14–86), 67% were male patients. A venoarterial ECMO was implanted in 73.6% (n = 581) and a venovenous in 26.4% of the patients (n = 209). Cannulation was performed percutaneously in 58.3%, mixed in 23.4% (venous percutaneous, arterial cut down), and surgically in 18.3%. ECMO-associated acute vascular complications with the need of surgical treatment occurred in 47 patients (6% with 5.5% compartment syndromes of the extremities). In the percutaneous group, the incidence was 6.5% (n = 30), in the mixed 8.1% (n = 13), and in the surgical 2.7% (n = 4), whereas contingency analysis revealed no significant difference (p = 0.33). Fifty-five per cent of the patients with complications died (n = 26, mostly due to multiorgan failure). Overall 30-day survival was 57%.

Conclusion: Our study shows that percutaneous and surgical ECMO implantation can be performed with comparable incidence of vascular complications. However, early diagnosis of these complications without delay in surgical treatment is crucial to avoid irreversible limb ischemia and subsequent amputation.

No conflict of interest has been declared by the author(s).