Percutaneous Postclosure vs Femoral Arterial Cutdown for Venoarterial Extracorporeal Membrane Cannulation Sites.

Abstract

This study sought to examine the outcomes of percutaneous postclosure of large-bore femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) cannulas compared with a traditional open cutdown technique. Between June 1, 2018 and December 31, 2023, a total of 103 unique consecutive patients underwent VA-ECMO, and 89 underwent subsequent decannulation by either open cutdown (n = 44) or percutaneous (n = 45) suture-mediated closure. The primary outcomes of interest were procedural success, vascular complications, and wound site infection after decannulation. Percutaneous postclosure was successful in 41 of 45 (91.1%) patients. In closure failures, 2 cannulas were inserted through the inguinal ligament, and 1 cannula involved the superficial femoral artery bifurcation. All failures were in patients with a body mass index ≥35 kg/m². Percutaneous closures were associated with reduced rates of groin infection (2.4% vs 18.8%; P = .04). There was no statistical difference in the rate of vascular complications after percutaneous closure (7.3% vs 20.8%; P = .13). Among patients undergoing isolated decannulation procedures, operating room time was significantly lower for percutaneously decannulated patients (75 [SD28] minutes vs 143 [45] minutes; P < .0001). Percutaneous decannulation of VA-ECMO sites can be achieved with high success rates and faster procedural time as well as lower groin infection rates when compared with a traditional open closure technique. Attention to detail at the time of cannulation is essential for successful decannulation.