Saiydoun Gabriel, Gall Emmanuel, Boukantar Madjid, Fiore Antonio, Mongardon Nicolas, Masi Paul, Bagate François, Radu Costin, Bergoend Eric, Mangiameli Andrea, de Roux Quentin, Mekontso Dessap Armand, Langeron Olivier, Folliguet Thierry, Teiger Emmanuel, Gallet Romain
Department of Cardiac Surgery, APHP, Hôpitaux Universitaires Henri Mondor, F-94010 Créteil, France.
Service de Cardiologie, APHP, Hôpitaux Universitaires Henri Mondor, F-94010 Créteil, France.
Resuscitation. 2022 Jan;170:92-99. doi: 10.1016/j.resuscitation.2021.11.018. Epub 2021 Nov 23.
Veno-arterial Extracorporeal Life Support (V-A ECLS) has gained increasing place into the management of patients with refractory cardiogenic shock or cardiac arrest. Both surgical and percutaneous approach can be used for cannulation, but percutaneous approach has been associated with fewer complications. Angio-guided percutaneous cannulation and decannulation may further decrease the rate of complication. We aimed to compare outcome and complication rates in patients supported with V-A ECLS through percutaneous angio-guided versus surgical approach.
We included all patients with emergent peripheral femoro-femoral V-A ECLS implantation for refractory cardiogenic shock or cardiac arrest in our center from March 2018 to March 2021. Survival and major complications (major bleeding, limb ischemia and groin infection) rates were compared between the percutaneous angio-guided and the surgical groups.
One hundred twenty patients received V-A ECLS, 59 through surgical approach and 61 through angio-guided percutaneous approach. Patients' baseline characteristics and severity scores were equally balanced between the 2 groups. Thirty-day mortality was not significantly different between the 2 approaches. However, angio-guided percutaneous cannulation was associated with fewer major vascular complications (42% vs. 11%, p > 0.0001) and a higher rate of V-A ECLS decannulation. In multivariate analysis, percutaneous angio-guided implantation of V-A ECLS was independently associated with a lower probability of major complications.
Compared to surgical approach, angio-guided percutaneous V-A ECLS implantation is associated with fewer major vascular complications. Larger studies are needed to confirm those results and address their impact on mortality.
静脉-动脉体外膜肺氧合（V-A ECLS）在难治性心源性休克或心脏骤停患者的治疗中应用越来越广泛。插管可采用外科手术和经皮穿刺两种方法，但经皮穿刺方法的并发症较少。血管造影引导下的经皮穿刺插管和拔管可能会进一步降低并发症发生率。我们旨在比较血管造影引导下经皮穿刺与外科手术方法进行V-A ECLS支持的患者的结局和并发症发生率。
我们纳入了2018年3月至2021年3月在本中心因难治性心源性休克或心脏骤停而紧急进行外周股-股V-A ECLS植入的所有患者。比较血管造影引导下经皮穿刺组和手术组的生存率和主要并发症（大出血、肢体缺血和腹股沟感染）发生率。
120例患者接受了V-A ECLS治疗，其中59例采用外科手术方法，61例采用血管造影引导下经皮穿刺方法。两组患者的基线特征和严重程度评分均衡。两种方法的30天死亡率无显著差异。然而，血管造影引导下经皮穿刺插管的主要血管并发症较少（42%对11%，p>0.0001），V-A ECLS拔管率较高。多因素分析显示，血管造影引导下经皮穿刺植入V-A ECLS与主要并发症发生概率较低独立相关。
与外科手术方法相比，血管造影引导下经皮穿刺植入V-A ECLS的主要血管并发症较少。需要更大规模的研究来证实这些结果，并探讨其对死亡率的影响。
