Sun Guangfeng, Huang Shan, Zhang Guoming, Zhang Zhixiang, Wang Bin
Department of Emergency, Xiamen Cardiovascular Hospital of Xiamen University, Xiamen, China.
School of Medicine, Xiamen University, Xiamen, China.
Perfusion. 2023 Aug 8:2676591231194761. doi: 10.1177/02676591231194761.
Our study aimed to compare the decannulation-related outcomes of two different decannulation methods in patients who underwent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support, namely percutaneous decannulation with Perclose ProGlide device and conventional surgical repair.
Surgical vascular repair is a standard strategy when ECMO is to be terminated and sometimes associated with severe complications. Percutaneous decannulation using Perclose ProGlide has been reported to be feasible and safe in selected patients, but there is a paucity of literature to make systematic comparisons between the two decannulation methods.
41 patients who were supported with VA-ECMO for refractory cardiogenic shock, cardiac arrest, or escort of complex interventions from December 2018 to December 2021 were enrolled. Of these, 30 underwent percutaneous Perclose ProGlide decannulation and 11 underwent surgical repair. The clinical characteristics and complication rates were analyzed.
Patients in the two groups showed a similar incidence of vascular-related complications, such as acute lower limb ischemia, major bleeding, severe hematoma, pseudoaneurysm, and arteriovenous fistula [20% versus 18.2%, =.896]. The incidence of groin infection and delayed healing was significantly higher in the surgical removal group [3.3% versus 36.4%, =.014].
Percutaneous decannulation of veno-arterial extracorporeal membrane oxygenation with the Perclose ProGlide device is a feasible and safe technique that simplifies the decannulation process, shortens the hospitalization duration, and lowers the potential risk of groin infection and delayed wound healing.
我们的研究旨在比较接受静脉-动脉体外膜肺氧合（VA-ECMO）支持的患者采用两种不同拔管方法（即使用Perclose ProGlide装置进行经皮拔管和传统手术修复）后的拔管相关结果。
当要终止体外膜肺氧合（ECMO）时，外科血管修复是一种标准策略，且有时会伴有严重并发症。据报道，在选定患者中使用Perclose ProGlide进行经皮拔管是可行且安全的，但缺乏文献对这两种拔管方法进行系统比较。
纳入了2018年12月至2021年12月期间因难治性心源性休克、心脏骤停或复杂干预的护送而接受VA-ECMO支持的41例患者。其中，30例接受了经皮Perclose ProGlide拔管，11例接受了手术修复。分析了临床特征和并发症发生率。
两组患者血管相关并发症（如急性下肢缺血、大出血、严重血肿、假性动脉瘤和动静脉瘘）的发生率相似[20%对18.2%，P = 0.896]。手术拔除组的腹股沟感染和延迟愈合发生率显著更高[3.3%对36.4%，P = 0.014]。
使用Perclose ProGlide装置对静脉-动脉体外膜肺氧合进行经皮拔管是一种可行且安全的技术，可简化拔管过程，缩短住院时间，并降低腹股沟感染和伤口延迟愈合的潜在风险。
