Fellow - Cardiovascular disease Allegheny General Hospital Allegheny General Hospital Pittsburgh, Pennsylvania, United States
Disclosure(s):
Aakash Tuli, MD: No financial relationships to disclose
Background: Over the last decade, there has been a steady increase in the utilization of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for managing cardiogenic shock. Traditionally, ECMO cannulation and decannulation were performed surgically, posing risks such as infection and systemic inflammatory response syndrome (SIRS) due to the invasive nature of the procedure.
Methods: Between January 1, 2024, and December 31, 2024, 88 patients underwent VA-ECMO runs at our institution. Out of these, 84 survived to decannulation, with 27 patients undergoing percutaneous decannulation in the cardiac catheterization lab and 61 patients undergoing standard surgical decannulation. Patient selection for percutaneous decannulation was determined by the location of VA-ECMO cannulation and the characteristics of vascular access. The cardiac catheterization lab was identified as the optimal environment for the procedure due to the availability of fluoroscopy and the ability to perform rescue interventions. The MANTA vascular closure device was used for percutaneous decannulation, allowing for rapid and reliable closure without prior preparation. Prior to decannulation, a comprehensive ECMO wean study, including echocardiography, was performed to assess the patient's readiness. The decannulation procedure involved femoral decannulation using the MANTA device, with Doppler ultrasound and peripheral angiography used to assess perfusion of the vessels distal to the device.
Outcome: The percutaneous decannulation technique demonstrated a 100% technical success rate. The overall 30-day all-cause mortality rate was 22.2%, with no mortalities related to the decannulation procedure. The most common complication was major bleeding, observed in 12 patients, while minor complications such as hematoma at the site of decannulation were observed in a small proportion of patients8. Importantly, no instances of limb ischemia or groin infections were reported. There was a trend towards shorter ICU length of stay and total hospital stay with percutaneous VA-ECMO decannulation compared to standard surgical decannulation, although this did not reach statistical significance
Conclusion: Our single-center experience demonstrates that percutaneous decannulation of femoral VA-ECMO using the MANTA closure device and dry closure technique is a safe and feasible approach with a high success rate and a low incidence of major complications, and potential alternative to standard surgical decannulation in appropriately selected patients.
