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Outcomes by cannulation methods for venovenous extracorporeal membrane oxygenation during COVID‐19: A multicenter retrospective study
Author(s) -
Saeed Omar,
Stein Louis H.,
Cavarocchi Nicolas,
Tatooles Antone J.,
Mustafa Asif,
Jorde Ulrich P.,
Alvarez Chikezie,
Gluck Jason,
Saunders Paul,
Abrol Sunil,
De Anda Abe,
Goldstein Daniel J.,
Silvestry Scott
Publication year - 2022
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.14213
Subject(s) - medicine , extracorporeal membrane oxygenation , cannula , surgery , retrospective cohort study , femoral vein , lumen (anatomy) , vein , deep vein , femoral artery , superior vena cava , thrombosis , anesthesia
Purpose To determine if a cannulation method for venovenous extracorporeal membrane oxygenation (V‐V ECMO) is related to patient outcome. Methods A retrospective, multicenter study of adult patients (≥18 years old) placed on V‐V ECMO for severe respiratory failure due to COVID‐19 between March 1, 2020, to April 30, 2021. Patients were divided into the following three groups based on the initial cannulation method: (1) femoral vein‐femoral vein or femoral vein‐internal jugular vein (dual‐site, C‐DS), (2) single, dual‐lumen cannula in internal jugular vein with tip positioned in the pulmonary artery (C‐PA), and (3) single, dual‐lumen cannula in internal jugular vein with tip positioned in the inferior vena cava (C‐IVC). The primary outcome was in‐hospital mortality assessed by a time‐to‐event analysis. Results Overall, 435 patients from 17 centers comprised the study cohort. C‐DS was performed in 247 (57%, age: 49, IQR:39–57 years; 30% female) cases, 99 (23%, age: 53, IQR: 42–59 years; 26% female) received C‐PA, and 89 (20%) patients got C‐IVC (age: 46, IQR 35–54; 33% female). At 90‐days, in‐hospital mortality was 60% (C‐DS), 41% (C‐PA), and 61% (C‐IVC), p = 0.06. After adjustment for clinical characteristics, the likelihood of in‐hospital mortality in comparison to C‐DS, was lower with C‐PA (aHR: 0.52, 95%CI 0.32–0.85, p = 0.009) and similar with C‐IVC (aHR: 0.96, 95%CI 0.63–1.47, p = 0.86). Conclusion Catheter‐directed flow into the PA bypassing the right ventricle with a single dual‐lumen cannula is associated with reduced mortality during V‐V ECMO for COVID‐19. These findings are limited by residual confounding and site‐clustering. Further investigation is urgently warranted with randomized studies.