Peripheral versus Central Cannulation for Extracorporeal Membrane Oxygenation: A Comparison of Limb Ischemia and Transfusion Requirements

Abstract

Extracorporeal membrane oxygenation (ECMO) can be instituted centrally, through the right atrium and ascending aorta, or peripherally, most commonly using the femoral artery and vein. We sought to investigate the impact of the mode of cannulation on the incidence of limb ischemia, perfusion and overall morbidity. A retrospective analysis of 50 consecutive patients over 5 years who underwent ECMO by central or peripheral cannulation was performed. There was no difference in the incidence of limb ischemia and end-organ perfusion when peripheral and central cannulation cohorts were compared. Central cannulation was associated with a higher incidence of bleeding from the cannulation site (64% vs. 18%, P = 0.002), blood product utilization and reoperation (66% vs. 14%, P < 0.0001). 30-day mortality was similar in both cohorts (46% peripheral, 50% central, P = 0.8). Our results suggest that there is comparable tissue perfusion and limb ischemia with both cannulation techniques. Central cannulation is associated with a higher incidence of bleeding, higher transfusion rates, a greater need for reoperation and greater resource utilization. Therefore, peripheral cannulation is safe and may be advantageous in certain clinical scenarios.