Outcomes by cannulation methods for venovenous extracorporeal membrane oxygenation during COVID‐19: A multicenter retrospective study.

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

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.

EXTRACORPOREAL membrane oxygenation; CATHETERIZATION; FEMORAL vein; COVID-19; HOSPITAL mortality

Artificial Organs, 2022, Vol 46, Issue 8, p1659

0160-564X

Academic Journal

10.1111/aor.14213