Percutaneous Cannulation for Extracorporeal Life Support

Abstract

Background: Extracorporeal life-support systems are valuable tools to treat patients with acute cardiopulmonary failure in intensive care facilities, and are highly suitable for the interhospital transfer of critically ill patients to specialized centers. This article reviews the cannulation strategies and associated vascular complications in our institution. Methods: Between January 2004 and December 2009, 464 extracorporeal life-support systems were implanted via percutaneous cannulation at our institution. The type and incidence of adverse events related to the percutaneous access to femoral, subclavian vessels and the jugular vein were retrospectively analyzed. The primary focus was on bleeding and limb ischemia. Results: 464 patients (340 male, 124 female) with isolated pulmonary or combined cardiopulmonary failure were connected to extracorporeal gas exchange systems. Most patients (n = 196) were connected to a PECLA system; 158 patients to a veno-arterial ECMO. Use of a veno-venous ECMO system was necessary in 110 cases. Thirty-two patients (6.9 %) suffered bleeding complications after cannula insertion, predominantly after PECLA placement (3.9 %). After implantation, limb ischemia developed in 15 cases (3.2 %), mostly in the veno-arterial ECMO group (n = 13). Demographic data and cannula size show no significant difference between patient groups with and without ischemic complications (p = 0.57). A prophylactic fasciotomy was performed in the 15 cases with limb ischemia. Survival was independent of ischemic (leg) complications. Conclusion: With proper vessel visualization, exposure and cannulation, and accurate cannula placement, optimal flows and minimal complication rates can be achieved, rendering percutaneous extracorporeal life support a safe procedure.

Key words

cardiopulmonary bypass - CPB - circulatory assist devices (IABP - LVAD - RVAD - BVAD - TAH) - cannulation

References

• 1 Hill J D, De Leval M R, Fallat R J et al. Acute respiratory insufficiency. Treatment with prolonged extracorporeal oxygenation.  J Thorac Cardiovasc Surg. 1972;  64 551-562
• 10 Bartlett R H, Gazzaniga A B, Jefferies M R et al. Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy.  Trans Am Soc Artif Intern Organs. 1976;  22 80-93
• 2 Kolobow T, Solca M, Gattinoni L, Pesenti A. Adult respiratory distress syndrome (ARDS): why did ECMO fail?.  Int J Artif Organs. 1981;  4 58-59
• 3 Schmid C, Phillipp A, Mueller T, Hilker M. Extracorporeal life support- systems, indications, and limitations.  Thorac Cardiov Surg. 2009;  57 449-454
• 4 Philipp A, Mueller T, Bein T et al. Inhibition of thrombocyte aggregation during extracorporeal lung assist: a case report.  Perfusion. 2007;  22 293-297
• 5 Flörchinger B, Philipp A, Klose A et al. Pumpless extracorporeal lung assist: a 10-year institutional experience.  Ann Thorac Surg. 2008;  86 410-417
• 6 Sabik J F, Lytle B W, McCarthy P M, Cosgrove D M. Axillary artery: an alternative site of arterial cannulation for patients with extensive aortic and peripheral vascular disease.  J Thorac Cardiovasc Surg. 1995;  109 885-890
• 7 Stulak J M, Dearani J A, Burkhardt H M, Barnes R D, Scott P D, Schears G J. ECMO cannulation controversies and complications.  Semin Cardiothorac Vasc Anesth. 2009;  13 176-182
• 8 Neri E, Massetti M, Capannini G et al. Axillary artery cannulation in type A aortic dissection operations.  J Thorac Cardiovasc Surg. 1999;  118 324-329
• 9 Russo C F, Cannata A, Vitali E, Lanfranconi M. Prevention of limb ischemia and edema during peripheral venoarterial extracorporeal membrane oxygenation in adults.  J Card Surg. 2009;  24 185-187