Division of Vascular Surgery, Department of General Surgery, Penn State University Milton S. Hershy Medical Center, Hershey, PA, USA -
Division of Vascular Surgery, Department of General Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA.
J Cardiovasc Surg (Torino). 2024 Jun;65(3):296-301. doi: 10.23736/S0021-9509.24.12874-1.
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a well-established treatment for severe cardio-pulmonary failure. The use of large bore cannulas in the femoral vessels for an extended period has been associated with significant wound complications. There is a lack of data analyzing risk factors that can mitigate such complications. The primary purpose of this study was to identify modifiable risk factors associated with femoral wound complications after VA ECMO decannulation.
Retrospective analysis of wound complications in patients following VA ECMO decannulation from 2014-2021 at a single academic institution were analyzed. Wound complications were defined as wound infection, dehiscence, or those wounds that were deliberately opened to promote healing by secondary intention.
Sixty patients underwent decannulation of VA ECMO with operative repair of the femoral artery. Fifteen patients were identified to have wound complications, eight (53%) of these had infection. Fourteen (93%) patients had wound dehiscence or had their wound purposely opened at bedside. Univariate analysis revealed no association of access-related complication with higher Body Mass Index (BMI, 28.3 vs. 32.7 kg/m, P=0.110) but here was a trend in having more wound complications in individuals with COVID-19 infection (6.7% vs. 26.7%, P=0.058). Patients that had dual cannulation with the arterial and venous cannulas in the same groin had significantly more wound complications compared to single cannulation arterial and venous cannulas in separate groins (57.8% vs. 93.3%; P=0.012). Multivariate analysis revealed same side cannulation (OR 18.05, 95% CI 1.44-226.18, P=0.025) and COVID-19 infection (OR 18.18, 95% CI 1.50-220.66, P=0.023) were independent predictors of wound complications.
Wound complications after VA ECMO decannulation is associated with COVID-19 infection and having venous and arterial cannulas in the same groin. We recommend that the arterial and venous cannulation be placed in different groins in patients that require VA ECMO.
静脉-动脉体外膜肺氧合（VA ECMO）是治疗严重心肺衰竭的一种成熟疗法。在股血管中使用大口径插管进行长时间治疗与显著的伤口并发症有关。目前缺乏分析可减轻此类并发症的危险因素的数据。本研究的主要目的是确定与 VA ECMO 拔管后股部伤口并发症相关的可改变危险因素。
对 2014 年至 2021 年在一家学术机构接受 VA ECMO 拔管的患者的伤口并发症进行回顾性分析。伤口并发症定义为伤口感染、裂开或那些故意打开以促进二期愈合的伤口。
60 例患者接受 VA ECMO 拔管，并对股动脉进行手术修复。有 15 例患者出现伤口并发症，其中 8 例（53%）发生感染。14 例（93%）患者的伤口裂开或在床边故意打开伤口。单变量分析显示，血管相关并发症与较高的体重指数（BMI，28.3 与 32.7 kg/m，P=0.110）无关，但 COVID-19 感染患者的伤口并发症发生率呈上升趋势（6.7%与 26.7%，P=0.058）。动脉和静脉插管在同一腹股沟的双插管患者与动脉和静脉插管在不同腹股沟的单插管患者相比，伤口并发症明显更多（57.8%与 93.3%；P=0.012）。多变量分析显示，同侧插管（OR 18.05，95%CI 1.44-226.18，P=0.025）和 COVID-19 感染（OR 18.18，95%CI 1.50-220.66，P=0.023）是伤口并发症的独立预测因素。
VA ECMO 拔管后伤口并发症与 COVID-19 感染和股部同一腹股沟内的动静脉插管有关。我们建议在需要 VA ECMO 的患者中，将动脉和静脉插管放置在不同的腹股沟。
