Association of Prophylactic Distal Perfusion Cannulation With Mortality in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation

• Published in: The American journal of cardiology Vol. 207; pp. 418 - 425
• Main Authors: Lee, Hyeok-Hee, Jang, Woo Jin, Ahn, Chul-Min, Chun, Woo Jung, Oh, Ju Hyeon, Park, Yong Hwan, Lee, Seung-Jun, Hong, Sung-Jin, Yang, Jeong Hoon, Kim, Jung-Sun, Kim, Hyeon Chang, Kim, Byeong-Keuk, Yu, Cheol Woong, Kim, Hyun-Joong, Bae, Jang-Whan, Ko, Young-Guk, Choi, Donghoon, Gwon, Hyeon-Cheol, Hong, Myeong-Ki, Jang, Yangsoo
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 15-11-2023; Elsevier Limited
• Subjects: Bleeding; Cannulation; Cardiac arrest; Catheters; distal perfusion; Extracorporeal membrane oxygenation; Health hazards; Hospitals; Intubation; Ischemia; Membranes; Mortality; Mortality risk; Oxygenation; Patients; Perfusion; prophylaxis; Risk; Safety; Sepsis; Variables; mortality; extracorporeal membrane oxygenation; prophylaxis; distal perfusion
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2023.07.149

Prophylactic distal perfusion cannulation (PDPC) is protectively associated with limb ischemia in patients with cardiogenic shock (CS) receiving femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, evidence supporting its benefits beyond limb ischemia reduction is scarce. We aimed to investigate whether PDPC, compared with no-PDPC, is associated with a lower risk of mortality in patients receiving VA-ECMO. From a multicenter registry, we identified 479 patients who underwent VA-ECMO support for refractory CS. The association of PDPC with 30-day mortality was assessed using multiple methods, including instrumental variable analysis, overlap weighting, and propensity score matching. Of the 479 patients, 154 (32.2%) received PDPC. The 30-day mortality rate was 33.1% in the PDPC group and 53.2% in the no-PDPC group. The instrumental variable analysis showed a protective association of PDPC with 30-day mortality (absolute risk difference −16.7%, 95% confidence interval −31.3% to −2.1%; relative risk 0.68, 95% confidence interval 0.40 to 0.96). The findings were consistent in the overlap-weighted analysis (hazard ratio 0.68, 95% confidence interval 0.48 to 0.98) and in the propensity score–matched analysis (hazard ratio 0.67, 95% confidence interval 0.45 to 1.00). There were no significant differences in safety outcomes, including stroke, ECMO site bleeding, gastrointestinal bleeding, and sepsis, between PDPC and no-PDPC. In conclusion, PDPC was associated with a lower risk of mortality at 30 days in patients with CS receiving VA-ECMO. The efficacy and safety of PDPC merit evaluation in future randomized studies.
Clinical trial registration: ClinicalTrials.gov; NCT02985008.