Subclavian versus femoral arterial cannulations during extracorporeal membrane oxygenation: A propensity-matched comparison

Mouhamed Djahoum Moussa (1) , Natacha Rousse (2) , Osama Abou Arab (3, 4) , Antoine Lamer (5, 6) , Guillaume Gantois , Jerome Soquet (2) , Vincent Liu , Agnès Mugnier (7) , Thibault Duburcq (1, 8) , Vincent Petitgand , Valentin Foulon , Jocelyn Dumontet , Delphine Deblauwe , Francis Juthier (2) , Jacques Desbordes , Valentin Loobuyck (2) , Julien Labreuche , Emmanuel Robin , André Vincentelli (2)

1 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
2 RNMCD - Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U1011
3 CHU Amiens-Picardie
4 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
5 Pole Cardio-vasculaire et pulmonaire [CHU Lille]
6 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
7 Institut Coeur Poumon [CHU Lille]
8 Université de Lille

Background During peripheral extracorporeal veno-arterial membrane oxygenation (VA-ECMO) support, subclavian arterial cannulation provides, in comparison to femoral arterial cannulation, an anterograde flow which may prevent from left ventricular (LV) distention and improve outcomes. We aimed to compare the effectiveness of subclavian cannulation to femoral cannulation in reducing LV overdistension consequences, hemostatic complications and mortality. Methods This retrospective study conducted in two intensive care units of the Lille academic hospitals from January 2013 to December 2019 included 372 non-moribund adult patients supported by VA-ECMO. The primary endpoint was a new onset of pulmonary edema (PO) or LV unloading. Secondary endpoints were myocardial recovery, serious bleeding (according to Extracorporeal Life Support Organization definition), thrombotic complications (a composite of stroke, cannulated limb or mesenteric ischemia, intracardiac or aortic-root thrombosis) and 28 day mortality. Differences in outcomes were analyzed using propensity score matching (PSM) and inverse probability of treatment weighting adjustment (IPTW). Results As compared to femoral cannulation (n = 320 patients), subclavian cannulation (n = 52 patients) did not reduce the occurrence of new onset of PO or LV unloading after PSM [HR 0.99 (95% CI 0.51–1.91)]. There was no other difference in outcomes in PSM cohort. In IPTW adjustment cohort, subclavian cannulation was associated with reduced recovery and increased serious bleeding with four accidental decannulations observed. Conclusion Subclavian artery cannulation was not associated with reduced LV distension related complications, thrombotic complications and 28 day mortality. Rather, it may increase serious bleeding and accidental decannulations, and reduce recovery. Therefore, subclavian cannulation should be limited to vascular accessibility issues.

Domaines: Sciences du Vivant [q-bio]

Mouhamed Djahoum Moussa, Natacha Rousse, Osama Abou Arab, Antoine Lamer, Guillaume Gantois, et al.. Subclavian versus femoral arterial cannulations during extracorporeal membrane oxygenation: A propensity-matched comparison. The Journal of Heart and Lung Transplantation, 2022, 41 (5), pp.608-618. ⟨10.1016/j.healun.2022.01.007⟩. ⟨hal-04010231⟩