AI Article Synopsis
- Venoarterial extracorporeal membrane oxygenation (ECMO) is used for patients in cardiac arrest, with peripheral cannulation methods being preferable for extracorporeal cardiopulmonary resuscitation (ECPR).
- A study at Daegu Catholic University Medical Center analyzed 99 ECPR patients, comparing surgical cutdown and percutaneous cannulation methods in terms of survival rates and insertion times.
- Both methods showed similar in-hospital survival rates (36.4% for surgical and 30.3% for percutaneous), but quicker ECMO insertion times were linked to better survival outcomes due to reduced low-flow times during resuscitation.
Article Abstract
Background: Venoarterial extracorporeal membrane oxygenation (ECMO) is a key treatment method used with patients in cardiac arrest who do not respond to medical treatment. A critical step in initiating therapy is the insertion of ECMO cannulas. Peripheral ECMO cannulation methods have been preferred for extracorporeal cardiopulmonary resuscitation (ECPR).
Methods: Patients who underwent ECPR at Daegu Catholic University Medical Center between January 2017 and May 2023 were included in this study. We analyzed the impact of 2 different peripheral cannulation strategies (surgical cutdown vs. percutaneous cannulation) on various factors, including survival rate.
Results: Among the 99 patients included in this study, 66 underwent surgical cutdown, and 33 underwent percutaneous insertion. The survival to discharge rates were 36.4% for the surgical cutdown group and 30.3% for the percutaneous group (p=0.708). The ECMO insertion times were 21.3 minutes for the surgical cutdown group and 10.3 minutes for the percutaneous group (p<0.001). The factors associated with overall mortality included a shorter low-flow time (hazard ratio [HR], 1.045; 95% confidence interval [CI], 1.019-1.071; p=0.001) and whether return of spontaneous circulation was achieved (HR, 0.317; 95% CI, 0.127-0.787; p=0.013). Low-flow time was defined as the time from the start of cardiopulmonary resuscitation to the completion of ECMO cannula insertion.
Conclusion: No statistically significant difference in in-hospital mortality was observed between the surgical and percutaneous groups. However, regardless of the chosen cannulation strategy, reducing ECMO cannulation time was beneficial, as a shorter low-flow time was associated with significant benefits in terms of survival.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11089061 | PMC |
| http://dx.doi.org/10.5090/jcs.23.118 | DOI Listing |
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