Abstract
BackgroundIt remains unclear which cannulation method is best in cases of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest. We assessed the effect of ultrasound- and fluoroscopy-guided percutaneous cannulation on complication incidence, compared with that using only ultrasound guidance.MethodsThis single-center retrospective observational study was conducted between February 2011 and December 2015. In the comparison group, cannulation was performed percutaneously using only ultrasound guidance. In the exposure group, cannulation was performed percutaneously using fluoroscopy and ultrasound guidance. The primary outcome assessed was whether complications were associated with cannulation. The secondary outcome assessed was the duration from hospital arrival to extracorporeal circulation start. In addition to univariate analysis, multivariate logistic-regression analysis for cannulation complications was performed to adjust for several presumed confounders.ResultsOf the patients who underwent ECPR, 73 were eligible; the comparison group included 50 cases and the exposure group included 23 cases. Univariate analysis showed that the complication incidence of the exposure group was significantly lower than that of the comparison group (8.7 vs. 36.0%, p = 0.022). Duration from hospital arrival to extracorporeal circulation start was almost the same in both groups (median, 17.0 min vs. 17.0 min, p = 0.92). After multivariate logistic regression analysis, cannulation using fluoroscopy and ultrasound was independently associated with a lower complication incidence (adjusted odds ratio, 0.14; p = 0.024).ConclusionsUltrasound- and fluoroscopy-guided cannulation may reduce the complication incidence of cannulation without delaying extracorporeal circulation start.
Highlights
It remains unclear which cannulation method is best in cases of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest
Several observational studies showed that Extracorporeal membrane oxygenation (ECMO)-assisted cardiopulmonary resuscitation, called extracorporeal cardiopulmonary resuscitation (ECPR), improved prognosis in special circumstances of of-hospital cardiac arrest (OHCA) [5,6,7,8,9,10]
This study aims to assess the effect of two percutaneous cannulation methods on complication incidence and time to ECMO start in ECPR for OHCA
Summary
It remains unclear which cannulation method is best in cases of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest. Despite the development of cardiopulmonary resuscitation (CPR), OHCA prognosis remains poor, with a survival rate of approximately 10% [1, 3, 4]. Extracorporeal membrane oxygenation (ECMO) is a technique for providing both cardiac and respiratory support to patients with cardiac or respiratory failure. Several observational studies showed that ECMO-assisted cardiopulmonary resuscitation, called extracorporeal cardiopulmonary resuscitation (ECPR), improved prognosis in special circumstances of OHCA [5,6,7,8,9,10]. The American Heart Association (AHA) and European Resuscitation Council (ERC) guidelines for CPR recommend considering ECMO in patients who have an reversible event and have had excellent CPR [11, 12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
