Veno-arterial Extracorporeal Membrane Oxygenation Decannulation: Surgical Cutdown Versus A New Percutaneous Occlusion Device
Mohammed F. Hassan, Daniel Beckles, Ramachandra Reddy.
Baylor Scott & White, Temple, TX, USA.
Objective: Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) has been used emergently on patients in cardiovascular or pulmonary collapse. Decannulation is most commonly performed using a surgical cut-down. The surgical approach has been associated with bleeding and wound complications. An alternative to the surgical approach is percutaneous decannulation. We have implemented the use of a new percutaneous occlusion device that does not require pre-ECMO wiring and acts by plugging the arteriotomy rather than cinching the arterial tissue. We set out to compare the use of a new percutaneous occlusion device with conventional surgical VA-ECMO decannulation.Method: Data was collected for VA-ECMO decannulations over the last 2 years including mean operative time, blood loss and use of transfusions. The average cost was also compared.Results: The percutaneous approach had a shorter procedure time (50 min vs 21 min), less bleeding (137 ml vs 550 ml) and lower rate of transfusion (0 vs 2 units) compared to the conventional approach. The percutaneous approach did not add to the total cost of the procedure.Conclusion: The use of a new percutaneous occlusion device for decannulation of VA-ECMO is a viable alternative to the conventional decannulation technique. Larger series are needed to further establish the efficacy.
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