Service de Cardiologie, APHP, Hôpitaux Universitaires Henri Mondor, 41 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.
AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 94010, Créteil, France.
Crit Care. 2021 Mar 7;25(1):93. doi: 10.1186/s13054-021-03522-8.
The approach for veno-arterial extracorporeal membrane oxygenation implantation (VA-ECMO) in patients with cardiogenic shock can be either surgical or percutaneous. Complete angio-guided percutaneous implantation and explantation could decrease vascular complications. We sought to describe the initial results of complete percutaneous angio-guided ECMO implantation and explantation using preclosing.
All consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation for refractory cardiogenic shock or cardiac arrest were enrolled in a prospective registry (03/2018-12/2020). Percutaneous preclosing using two closing devices (Perclose ProGlide, Abbott) inserted before cannulation was used in both femoral artery and vein. Explantation was performed using a crossover technique under angiographic guidance. The occurrence of vascular complication was recorded.
Among the 56 patients who underwent percutaneous VA-ECMO implantation for cardiogenic shock or refractory cardiac arrest, 41 underwent preclosing. Femoral vessel cannulation was successful in all patients and total cannulation time was 20 (10-40) min. Weaning from ECMO was possible in 22/41 patients (54%) and 12 (29%) patients were alive at day 30. Significant vascular complications occurred in 2/41 patients. Percutaneous decannulation was performed in 20 patients with 19/20 technical success rate. All femoral arteries and veins were properly closed using the pre-closing devices without bleeding on the angiographic control except for one patient in whom surgical closure of the artery was required. No patient required transfusion for access related significant bleeding and no other vascular complication occurred. Furthermore, no groin infection was observed after full percutaneous implantation and removal of ECMO.
Emergent complete percutaneous angio-guided VA-ECMO implantation and explantation using pre-closing technique can be an attractive strategy in patients referred for refractory cardiogenic shock.
心源性休克患者的血管-动脉体外膜肺氧合（VA-ECMO）植入方法可以是外科手术或经皮。完全血管引导的经皮植入和拔出可以减少血管并发症。我们旨在描述使用预闭技术进行完全经皮血管引导 ECMO 植入和拔出的初步结果。
所有因难治性心源性休克或心脏骤停而行外周股-股 VA-ECMO 经皮植入的连续患者均被纳入前瞻性登记（2018 年 3 月至 2020 年 12 月）。在股动脉和静脉置管前，使用两种闭合装置（雅培 Perclose ProGlide）进行经皮预闭。在血管造影引导下使用交叉技术进行拔出。记录血管并发症的发生情况。
在 56 例因心源性休克或难治性心脏骤停而行经皮 VA-ECMO 植入的患者中，41 例行预闭。所有患者的股血管置管均成功，总置管时间为 20（10-40）min。22/41 例（54%）患者可从 ECMO 中脱机，12 例（29%）患者在第 30 天存活。41 例患者中有 2 例发生显著血管并发症。20 例患者进行了经皮拔管，其中 19/20 例技术成功。除 1 例患者需要手术关闭动脉外，所有患者均使用预闭装置正确闭合股动脉和静脉，无出血。除 1 例患者因血管通路相关严重出血需要输血外，无其他血管并发症发生。此外，在 ECMO 完全经皮植入和拔出后，未观察到腹股沟感染。
使用预闭技术紧急进行完全经皮血管引导 VA-ECMO 植入和拔出可以成为难治性心源性休克患者的一种有吸引力的策略。
