Authors (including presenting author) :
Au SY(1), Fong KM(1), Leung PWR(1), Ng WYG(1), So SO(1), Leung KHA(1)
Affiliation :
(1) Intensive Care Unit, Queen Elizabeth Hospital
Introduction :
Veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) is a form of mechanical circulatory support for cardiogenic shock. Its demand has been rapidly growing in HA, especially with the initiation of 24-7 primary PCI service. When VA-ECMO support can be terminated, arteriotomy wounds of the patients of are traditionally closed by open repair in the operation theaters. Lots of manpower including ECMO specialists, vascular surgeons, anesthetists etc. are involved and timeslots in operating theaters are scarce. Transport of the critically-ill is risky. Successful VA-ECMO decannulation using percutaneous device called ProGlide was described by JW Hwang et al.
Objectives :
Our group had adopted and modified this approach and the detailed ultrasound guided technique had been published. We reviewed if this new approach was safe and effective.
Methodology :
This is a retrospective study analyzing the one-year experience of bedside VA-ECMO decannulation. Our institution is a 23-bed tertiary ECMO referral center in Hong Kong. Our first bedside VA-ECMO decannulation was performed in November 2018, and since then, this practice had replaced the traditional open repair, unless percutaneous closure was contraindicated. Data from November 2018 to October 2019 were analyzed.
Result & Outcome :
In the study period, 39 patients received VA-ECMO support, 28 survived to decannulation and 25 received bedside percutaneous decannulation. Their median age was 59 (52-67) and the APACHE IV score was 119 (96.75-134.75). The default arterial catheter size was 17Fr, with 15 Fr in 3 cases and 19Fr in one. Five (20%) failed percutaneous closure; among then, all had 17 Fr catheters and their wounds, subsequently were successfully repaired surgically without additional complications. Among the 20 successful cases, 2 ProGlides were used in 15 cases and 3 used in 5 cases. In the case of the 19Fr arteriotomy wound, apart from 3 ProGlides, one 8Fr Angioseal was employed. The median procedure time was 27 minutes (15-45), which was much faster as compared to 2.5 hours by open repair. Median blood loss was 300mL (250-400). Post procedural clinical and ultrasound Doppler examination revealed minor complications in 4 patients, including 2 arterial clots and one pseudoaneurysm who were managed conservatively and one wound infection requiring exploration. There were no other major vascular complications including acute ischemia, arterial dissection or death related to the procedure. We conclude that this approach not only saved resources but safe and effective.
