Complete percutaneous angio-guided approach using preclosing for venoarterial extracorporeal membrane oxygenation implantation and explantation in patients with refractory cardiogenic shock or cardiac arrest

Critical Care

Armand Mekontso-Dessap¹  François Bagate¹  Thierry Folliguet²  Antonio Fiore²  Gabriel Saiydoun²  Gauthier Mouillet³  Andrea Mangiameli³  Laura Rostain³  Anne-Sophie Martin-Tuffreau³  Madjid Boukantar³  Emmanuel Teiger⁴  Romain Gallet⁴  Olivier Langeron⁵  Nicolas Mongardon⁶ 

[1] AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 94010, Créteil, France;Univ Paris Est Créteil, CARMAS, 94010, Créteil, France;Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France;Department of Cardiac Surgery, APHP, Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France;Service de Cardiologie, APHP, Hôpitaux Universitaires Henri Mondor, 41 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France;Service de Cardiologie, APHP, Hôpitaux Universitaires Henri Mondor, 41 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France;U955-IMRB, Equipe 03, Inserm, Univ Paris Est Creteil (UPEC), Ecole Nationale Vétérinaire D’Alfort (EnVA), 94700, Maisons-Alfort, France;Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France;Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France;U955-IMRB, Equipe 03, Inserm, Univ Paris Est Creteil (UPEC), Ecole Nationale Vétérinaire D’Alfort (EnVA), 94700, Maisons-Alfort, France;

关键词: ECMO;    Percutaneous cannulation;    Closure device;    Cardiac arrest;    Cardiogenic shock;   

DOI  :  10.1186/s13054-021-03522-8

来源: Springer

【 摘 要 】

BackgroundThe approach for veno-arterial extracorporeal membrane oxygenation implantation (VA-ECMO) in patients with cardiogenic shock can be either surgical or percutaneous. Complete angio-guided percutaneous implantation and explantation could decrease vascular complications. We sought to describe the initial results of complete percutaneous angio-guided ECMO implantation and explantation using preclosing.MethodsAll consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation for refractory cardiogenic shock or cardiac arrest were enrolled in a prospective registry (03/2018–12/2020). Percutaneous preclosing using two closing devices (Perclose ProGlide, Abbott) inserted before cannulation was used in both femoral artery and vein. Explantation was performed using a crossover technique under angiographic guidance. The occurrence of vascular complication was recorded.ResultsAmong the 56 patients who underwent percutaneous VA-ECMO implantation for cardiogenic shock or refractory cardiac arrest, 41 underwent preclosing. Femoral vessel cannulation was successful in all patients and total cannulation time was 20 (10–40) min. Weaning from ECMO was possible in 22/41 patients (54%) and 12 (29%) patients were alive at day 30. Significant vascular complications occurred in 2/41 patients. Percutaneous decannulation was performed in 20 patients with 19/20 technical success rate. All femoral arteries and veins were properly closed using the pre-closing devices without bleeding on the angiographic control except for one patient in whom surgical closure of the artery was required. No patient required transfusion for access related significant bleeding and no other vascular complication occurred. Furthermore, no groin infection was observed after full percutaneous implantation and removal of ECMO.ConclusionEmergent complete percutaneous angio-guided VA-ECMO implantation and explantation using pre-closing technique can be an attractive strategy in patients referred for refractory cardiogenic shock.

【 授权许可】

CC BY