Bilateral Femoral Cannulation Is Associated With Reduced Severe Limb Ischemia-Related Complications Compared With Unilateral Femoral Cannulation in Adult Peripheral Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Registry*
Main findingResult — go to the resultOdds ratio 0.92 95% CI 0.82–1.02Authors' conclusion
This study showed no risk reduction for overall limb ischemia-related events requiring DPC after 6 hours when comparing bilateral to unilateral femoral cannulation in peripheral venoarterial ECMO. However, bilateral cannulation was associated with a reduced risk for compartment syndrome/fasciotomy, lower rates of bleeding and vessel repair during ECMO, and lower in-hospital mortality.
Study context
- Population
- Adults (≥ 18 yr) receiving peripheral venoarterial extracorporeal membrane oxygenation (ECMO) with femoral access, Extracorporeal Life Support Organization registry, 2014–2020
- Participants
- 19,093 adults
- Exposure
- Bilateral vs unilateral femoral cannulation
- Bilateraln = 7,128
- Unilateraln = 11,965reference
- Outcome
- Limb ischemia: composite of need for distal perfusion cannula (DPC) after 6 hours from implantation, compartment syndrome/fasciotomy, amputation, revascularization, and thrombectomy
Methodological detailsregistry-based, propensity score matching
- Registry-based
- Propensity score matching
Main finding
As reported in the abstract
Odds ratio
0.92
95% CI 0.82–1.02
Bilateral vs Unilateral
OR 0.92 (95% CI 0.82–1.02)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | OR (95% CI) | |
|---|---|---|
| Compartment syndrome/fasciotomy | 0.80 (0.66–0.97) | |
| In-hospital mortalityUnchanged after propensity matching | 0.85 (0.81–0.91) | |
| 0.512Odds ratio (log scale) |
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| Cannulation site bleeding | 0.87 (0.76–0.99) | |
| Vessel repair | 0.55 (0.38–0.79) | |
| 0.20.5125Odds ratio (log scale) |
Original publication
Bilateral Femoral Cannulation Is Associated With Reduced Severe Limb Ischemia-Related Complications Compared With Unilateral Femoral Cannulation in Adult Peripheral Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Registry*. Crit Care Med. Published 5 September 2023. doi:10.
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