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J Chest Surg

Published online March 13, 2024

Copyright © Journal of Chest Surgery.

Differences in Treatment Outcomes According to the Insertion Method Used in Extracorporeal Cardiopulmonary Resuscitation: A Single-Center Experience

Han Sol Lee , M.D., Chul Ho Lee , M.D., Jae Seok Jang , M.D., Jun Woo Cho , M.D., Yun-Ho Jeon , M.D.

Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine, Daegu, Korea

Correspondence to:Chul Ho Lee
Tel 82-53-650-4876
Fax 82-53-629-6963
E-mail dewdew19@hanmail.net
ORCID
https://orcid.org/0000-0002-9139-0619

Received: August 22, 2023; Revised: December 19, 2023; Accepted: January 18, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Venoarterial extracorporeal membrane oxygenation (ECMO) is a key treatment method used with patients in cardiac arrest who do not respond to medical treatment. A critical step in initiating therapy is the insertion of ECMO cannulas. Peripheral ECMO cannulation methods have been preferred for extracorporeal cardiopulmonary resuscitation (ECPR).
Methods: Patients who underwent ECPR at Daegu Catholic University Medical Center between January 2017 and May 2023 were included in this study. We analyzed the impact of 2 different peripheral cannulation strategies (surgical cutdown vs. percutaneous cannulation) on various factors, including survival rate.
Results: Among the 99 patients included in this study, 66 underwent surgical cutdown, and 33 underwent percutaneous insertion. The survival to discharge rates were 36.4% for the surgical cutdown group and 30.3% for the percutaneous group (p=0.708). The ECMO insertion times were 21.3 minutes for the surgical cutdown group and 10.3 minutes for the percutaneous group (p<0.001). The factors associated with overall mortality included a shorter low-flow time (hazard ratio [HR], 1.045; 95% confidence interval [CI], 1.019–1.071; p=0.001) and whether return of spontaneous circulation was achieved (HR, 0.317; 95% CI, 0.127–0.787; p=0.013). Low-flow time was defined as the time from the start of cardiopulmonary resuscitation to the completion of ECMO cannula insertion.
Conclusion: No statistically significant difference in in-hospital mortality was observed between the surgical and percutaneous groups. However, regardless of the chosen cannulation strategy, reducing ECMO cannulation time was beneficial, as a shorter low-flow time was associated with significant benefits in terms of survival.

Keywords: Extracorporeal membrane oxygenation, Extracorporeal cardiopulmonary resuscitation, ECMO cannulation

Article

ahead

J Chest Surg

Published online March 13, 2024

Copyright © Journal of Chest Surgery.

Differences in Treatment Outcomes According to the Insertion Method Used in Extracorporeal Cardiopulmonary Resuscitation: A Single-Center Experience

Han Sol Lee , M.D., Chul Ho Lee , M.D., Jae Seok Jang , M.D., Jun Woo Cho , M.D., Yun-Ho Jeon , M.D.

Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine, Daegu, Korea

Correspondence to:Chul Ho Lee
Tel 82-53-650-4876
Fax 82-53-629-6963
E-mail dewdew19@hanmail.net
ORCID
https://orcid.org/0000-0002-9139-0619

Received: August 22, 2023; Revised: December 19, 2023; Accepted: January 18, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Venoarterial extracorporeal membrane oxygenation (ECMO) is a key treatment method used with patients in cardiac arrest who do not respond to medical treatment. A critical step in initiating therapy is the insertion of ECMO cannulas. Peripheral ECMO cannulation methods have been preferred for extracorporeal cardiopulmonary resuscitation (ECPR).
Methods: Patients who underwent ECPR at Daegu Catholic University Medical Center between January 2017 and May 2023 were included in this study. We analyzed the impact of 2 different peripheral cannulation strategies (surgical cutdown vs. percutaneous cannulation) on various factors, including survival rate.
Results: Among the 99 patients included in this study, 66 underwent surgical cutdown, and 33 underwent percutaneous insertion. The survival to discharge rates were 36.4% for the surgical cutdown group and 30.3% for the percutaneous group (p=0.708). The ECMO insertion times were 21.3 minutes for the surgical cutdown group and 10.3 minutes for the percutaneous group (p<0.001). The factors associated with overall mortality included a shorter low-flow time (hazard ratio [HR], 1.045; 95% confidence interval [CI], 1.019–1.071; p=0.001) and whether return of spontaneous circulation was achieved (HR, 0.317; 95% CI, 0.127–0.787; p=0.013). Low-flow time was defined as the time from the start of cardiopulmonary resuscitation to the completion of ECMO cannula insertion.
Conclusion: No statistically significant difference in in-hospital mortality was observed between the surgical and percutaneous groups. However, regardless of the chosen cannulation strategy, reducing ECMO cannulation time was beneficial, as a shorter low-flow time was associated with significant benefits in terms of survival.

Keywords: Extracorporeal membrane oxygenation, Extracorporeal cardiopulmonary resuscitation, ECMO cannulation

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