Roberts Sophia H, Schumer Erin M, Sullivan Mary, Grotberg John, Jenkins Bianca, Fischer Irene, Damiano Marci, Schill Matthew R, Masood Muhammad F, Kotkar Kunal, Pawale Amit
Division of Cardiac Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Mo.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Mo.
JTCVS Open. 2024 Jan 26;18:80-86. doi: 10.1016/j.xjon.2024.01.012. eCollection 2024 Apr.
Open decannulation from femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) carries high risk of morbidity, including groin wound infection. This study evaluated the impact of percutaneous decannulation on rates of groin wound infection in patients decannulated from femoral VA-ECMO.
Between January 1, 2022, and April 30, 2023, 47 consecutive patients received percutaneous femoral VA-ECMO and survived to decannulation. A percutaneous suture-mediated closure device was used for decannulation in patients with relatively smaller arterial cannulas. Patients with larger arterial cannulas or unsuccessful percutaneous closures underwent surgical cutdown and repair of the femoral artery. The primary outcome was arterial site wound infection following decannulation.
Among the 47 patients who survived to decannulation from VA-ECMO, 21 underwent percutaneous decannulation and 27 underwent surgical cutdown. One patient underwent 2 VA-ECMO runs, one with percutaneous decannulation and one with surgical cutdown. Percutaneous decannulation was attempted in 22 patients, with 21 of 22 (95.5%) success rate. Decannulation procedure length was significantly shorter in the percutaneous group (79 minutes vs 148 minutes, = .0001). The percutaneous group had significantly reduced rates of groin wound complications (0% vs 40.7%, = .001) and groin wound infections (0% vs 22.2%, = .03) when compared with the surgical cutdown group. Three patients (14.3%) in the percutaneous group experienced vascular complications, including pseudoaneurysm at the distal perfusion catheter site and nonocclusive thrombus of the common femoral artery.
Percutaneous decannulation may reduce decannulation procedure length and rate of groin wound infection in patients who survive to decannulation from VA-ECMO.
股动静脉体外膜肺氧合（VA-ECMO）开放拔管具有较高的发病风险，包括腹股沟伤口感染。本研究评估了经皮拔管对接受股动静脉VA-ECMO治疗后拔管患者腹股沟伤口感染率的影响。
在2022年1月1日至2023年4月30日期间，47例连续接受经皮股动静脉VA-ECMO治疗并存活至拔管的患者。对于动脉插管相对较小的患者，使用经皮缝线介导的闭合装置进行拔管。动脉插管较大或经皮闭合失败的患者接受手术切开并修复股动脉。主要结局是拔管后动脉部位伤口感染。
在47例存活至VA-ECMO拔管的患者中，21例接受了经皮拔管，27例接受了手术切开。1例患者接受了2次VA-ECMO治疗，1次为经皮拔管，1次为手术切开。22例患者尝试经皮拔管，22例中有成功21例（成功率95.5%）。经皮组的拔管过程时间明显更短（79分钟对148分钟，P = 0.0001）。与手术切开组相比，经皮组腹股沟伤口并发症发生率（0%对40.7%，P = 0.001）和腹股沟伤口感染率（0%对22.2%，P = 0.03）显著降低。经皮组3例患者（14.3%）出现血管并发症，包括远端灌注导管部位假性动脉瘤和股总动脉非闭塞性血栓形成。
经皮拔管可能会缩短接受VA-ECMO治疗后存活至拔管患者的拔管过程时间和腹股沟伤口感染率。
