OC39 META-ANALYSIS OF PERIPHERAL OR CENTRAL ECMO IN POSTCARDIOTOMY AND NON-POSTCARDIOTOMY SHOCK

Abstract

Abstract Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) application in post-cardiotomy shock (PCS) and non-PCS is increasing. VA-ECMO plays a critical role in the management of these patients, yet may be associated with serious complications. Methods: A systematic review of all available reports in the literature of patients receiving VA-ECMO, either directly or indirectly comparing central cannulation (right atrial to ascending aorta) versus peripheral cannulation (femoral vein to femoral artery or axillary artery) were analyzed. The primary endpoint was survival. Cerebrovascular events, limb complications, bleeding requiring reoperation, sepsis, continuous veno-venous hemofiltration, and transfusions, were also assessed in both groups. Results: Seventeen retrospective case series clearly describing the VA-ECMO access and including 1,691 patients with PC- and non-PCS were found. The peripheral approach was more commonly used (980 patients, 57.9%) than the central one. There was no difference in the analysis between the two techniques regarding all-cause mortality RR (Risk Ratio) 95 CIs (Confidence Intervals): 1.00 (0.94–1.08) I2 = 0%, P = 0.92. No statistical differences were found between peripheral and central VA-ECMO with regards to cerebrovascular events, limb complications, or sepsis rates. Peripheral cannulation, was associated with a significant reduction in the risk of bleeding (p = 0.02), continuous veno-venous hemofiltration (p = 0.03), transfusion of red blood cells units (p < 0.00001), fresh frozen plasma units (p = 0.0002) and platelets units (p < 0.00001). Conclusions: Peripheral and central VA-ECMO configurations showed comparable in-hospital survival in PCS and non-PCS. The risk of bleeding, continuous veno-venous hemofiltration and blood product transfusion was significantly lower with the peripheral cannulation strategy.