Axillary ECMO after Cardiac Surgery: Weaning and Early Outcome in 179 Consecutive Patients

Background: In acute heart failure or low cardiac output after cardiac surgery, extracorporeal membrane oxygenation (ECMO) provides sufficient short-term life support. Still, retrograde flow and incomplete unloading of the left ventricle often complicates recovery of the heart, especially when cannulated via the femoral artery. Therefore, access through the axillary artery might be beneficial. In this study we present our data of 179 consecutive patients after ECMO via the axillary artery.

Method: We completed a retrospective study on 179 consecutive patients who were supported with ECMO after cardio-thoracic surgery between January 2014 and January 2019 in our department. Mean age was 67.0 ±10.9 years. 60 patients (33.5%) were females. Seventy-eight patients (43.5%) were operated electively, 37 patients urgently (20.7%) and 64 patients (35.8%) needed emergency operation. 67 patients (37.4%) were resuscitated preoperatively.

ECMO support after isolated CABG was in 68 patients (37.9%), isolated valvular surgery in 39 patients (21.7%), combined CABG and valvular surgery in 37 patients (20.6%), combined aortic surgery in 24 patients (12.9%), isolated aortic surgery in 5 patients (2.7%) and others in 6 patients (3.3%).

In 93 patients (52%) ECMO was implanted intraoperatively due to impossible weaning from cardio-pulmonary bypass while in 86 patients (48%) the ECMO was required postoperatively due to Low cardiac Output. A standardized weaning protocol was used to optimize the weaning process after myocardial recovery.

Results: Mean duration of ECMO support was 8.4 ± 5.1 days. Mean ICU stay was 18.8 ± 15.8 days and mean hospital stay was 23.48 ±22.6. Axillary bleeding occurred in 24 patients (13.4%) and femoral bleeding in 4 patients (2.2%), re-sternotomy due to bleeding in 20 patients (11.1%), ischemia of the upper limb in 11 patients (6.1%), lower limb in 13 patients (7.2%), renal replacement therapy was needed postoperatively in 150 patients (83.8%), intracerebral bleeding occurred in 9 patients (5.0%) and stroke in 19 patients (10.0%). Weaning from ECMO was successful in 87 patients (48.6%), hospital survival was achieved in 62 patients (34.6%) and 1 year survival in 46 patients (25.7%).

Conclusion: This study shows, almost half of the patients requiring ECMO after cardio-thoracic surgery were successfully weaned due to myocardial recovery using the axillary access, 34.6% of the patients survived to discharge and most of them were alive 1 year after surgery. These data suggest that cannulation of the axillary artery provides a safe and perhaps preferable access for ECMO support.

Publication History

Article published online:
03 February 2022