Complete percutaneous angio-guided approach using preclosing for venoarterial extracorporeal membrane oxygenation implantation and explantation in patients with refractory cardiogenic shock or cardiac arrest - Université Paris-Est-Créteil-Val-de-Marne Access content directly
Journal Articles Critical Care Year : 2021

Complete percutaneous angio-guided approach using preclosing for venoarterial extracorporeal membrane oxygenation implantation and explantation in patients with refractory cardiogenic shock or cardiac arrest

Anne-Sophie Martin-Tuffreau
  • Function : Author
François Bagate
  • Function : Author
Madjid Boukantar
  • Function : Author
Gabriel Saiydoun
  • Function : Author
Andrea Mangiameli
  • Function : Author
Laura Rostain
  • Function : Author
Gauthier Mouillet
  • Function : Author
Antonio Fiore
  • Function : Author
Olivier Langeron
  • Function : Author
Nicolas Mongardon
  • Function : Author
Thierry Folliguet
  • Function : Author
Emmanuel Teiger
  • Function : Author
Romain Gallet

Abstract

Abstract Background The approach for veno-arterial extracorporeal membrane oxygenation implantation (VA-ECMO) in patients with cardiogenic shock can be either surgical or percutaneous. Complete angio-guided percutaneous implantation and explantation could decrease vascular complications. We sought to describe the initial results of complete percutaneous angio-guided ECMO implantation and explantation using preclosing. Methods All consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation for refractory cardiogenic shock or cardiac arrest were enrolled in a prospective registry (03/2018–12/2020). Percutaneous preclosing using two closing devices (Perclose ProGlide, Abbott) inserted before cannulation was used in both femoral artery and vein. Explantation was performed using a crossover technique under angiographic guidance. The occurrence of vascular complication was recorded. Results Among the 56 patients who underwent percutaneous VA-ECMO implantation for cardiogenic shock or refractory cardiac arrest, 41 underwent preclosing. Femoral vessel cannulation was successful in all patients and total cannulation time was 20 (10–40) min. Weaning from ECMO was possible in 22/41 patients (54%) and 12 (29%) patients were alive at day 30. Significant vascular complications occurred in 2/41 patients. Percutaneous decannulation was performed in 20 patients with 19/20 technical success rate. All femoral arteries and veins were properly closed using the pre-closing devices without bleeding on the angiographic control except for one patient in whom surgical closure of the artery was required. No patient required transfusion for access related significant bleeding and no other vascular complication occurred. Furthermore, no groin infection was observed after full percutaneous implantation and removal of ECMO. Conclusion Emergent complete percutaneous angio-guided VA-ECMO implantation and explantation using pre-closing technique can be an attractive strategy in patients referred for refractory cardiogenic shock.

Dates and versions

hal-04395401 , version 1 (15-01-2024)

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Anne-Sophie Martin-Tuffreau, François Bagate, Madjid Boukantar, Gabriel Saiydoun, Andrea Mangiameli, et al.. Complete percutaneous angio-guided approach using preclosing for venoarterial extracorporeal membrane oxygenation implantation and explantation in patients with refractory cardiogenic shock or cardiac arrest. Critical Care, 2021, 25 (1), pp.93. ⟨10.1186/s13054-021-03522-8⟩. ⟨hal-04395401⟩

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