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Femoro-Femoral vs. Atrio-Aortic Extracorporeal Membrane Oxygenation: Which Cannulation Technique is Better?
Diyar Saeed, Hanna Stosik, Merima Islamovic, Alexander Albert, Hiroyuki Kamiya, Artur Lichtenberg.
Heinrich-Heine University Duesseldorf, Duesseldorf, Germany.
OBJECTIVE:
Patients necessitating veno-arterial extracorporeal membrane oxygenation (ECMO) may be cannulated using femoro-femoral (pECMO) or open sternotomy and atrio-aortic (cECMO) technique. Some centers prefer the atrio-aortic technique with a theoretical advantage of obtaining a better hemodynamic/oxygenation. We aimed to compare these 2 cannulation techniques.
METHODS:
A retrospective study was performed from 10.2009 through 06.2011. Inclusion criteria were patients with veno-arterial ECMO support of ≥24 hours. Various pre-and postimplantation variables were investigated including postimplantation hemodynamic and ECMO parameters, oxygenation/ventilation, cathecholamine requirements at 3, 6, 12, 24, 48, 72 hours as well as renal and liver function tests at 1, 3, and 7 days following implantation. Outcomes of patients receiving pECMO were compared to those who receive cECMO.
RESULTS:
A total of 52 ECMOs were implanted. The inclusion criteria were met by 37 patients (25 pECMO and 12 cECMO). ECMO indications were cardiogenic shock (32), ARDS (3) and pulmonary embolism (2). There were no significant differences in baseline characteristics between these 2 groups except for younger age in pECMO patients of 59 ± 16 vs. 70 ± 5 yo in cECMO patients (p<0.05). Average duration of support in patients with pECMO and cECMO was 5.8 ± 4.3 and 6.0 ± 4.0 days respectively (p=0.8). All postimplantation variables were comparable between the 2 groups except for higher PO2 and lower PCO2 values at 3rd hour postimplantation in patients with pECMO (p<0.05) (Figure 1). Furthermore, a tendency towards higher AST and ALT values in patients with cECMO was observed (p=0.05). Ten (53%) of the pECMO patients required reexploration of bleeding vs. 100% of patients with cECMO (p=0.01). Ischemic leg complication was observed in 4 pECMO patients. 30 day mortality in patients with pECMO and cECMO was 60 vs. 67 % respectively (p=ns).
CONCLUSIONS:
In this study, no particular oxygenation/ventilation, hemodymanic, or end organ function advantage was observed with either cannulation technique except for avoiding ischemic leg complications in cECMO group. However, more bleeding complication was observed in cECMO patients. 
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