Cannulation-related adverse events of peripheral veno-arterial extracorporeal membrane oxygenation support in heart transplantation: Axillary versus femoral artery cannulation.

Abstract

In heart transplantation (HT), peripheral veno-arterial extracorporeal membranous oxygenation (VA-ECMO) is utilized preoperatively as a direct bridge to HT or postoperatively for primary graft dysfunction (PGD). Little is known about wound complications of an arterial VA-ECMO cannulation site which can be fatal. From 2009 to 2021, outcomes of 80 HT recipients who were supported with peripheral VA-ECMO either preoperatively or postoperatively were compared based on the site of arterial cannulation: axillary (AX: N=49) versus femoral artery (FA: N=31). Patients in the AX group were older (AX: 59 years vs. 52 years, p=.006), and less likely to have extracorporeal cardiopulmonary resuscitation (0%vs. 12.9%, p=.040). Survival to discharge (AX, 81.6%vs. FA. 90.3%, p=.460), incidence of stroke (10.2%vs. 6.5%, p=.863), VA-ECMO cannulation-related bleeding (6.1%vs. 12.9%, p=.522), and arm or limb ischemia (0%vs. 3.2%, p=.816) were comparable. ECMO cannulation-related wound complications were lower in the AX group (AX, 4.1%vs. FA, 45.2%, p<.001) including the wound infections (2.0%vs. 32.3%, p<.001). In FA group, all organisms were gram-negative species. In univariate logistic regression analysis, AX cannulation was associated with less ECMO cannulation-related wound complications (Odds ratio, .23, p<.001). There was no difference between cutdown and percutaneous FA insertion regarding cannulation-related complications. Given the lower rate of wound complications and comparable hospital outcomes with femoral cannulation, axillary VA-ECMO may be an excellent option in HT candidates or recipients when possible.