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Impact of Cannula Size on Clinical Outcomes in Peripheral Venoarterial Extracorporeal Membrane Oxygenation

Kim, Juwon*; Cho, Yang Hyun; Sung, Kiick; Park, Taek Kyu*; Lee, Ga Yeon*; Lee, Joo Myung*; Song, Young Bin*; Hahn, Joo-Yong*; Choi, Jin-Ho*; Choi, Seung-Hyuk*; Gwon, Hyeon-Cheol*; Yang, Jeong Hoon*,‡

doi: 10.1097/MAT.0000000000000858
Adult Circulatory Support
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Venoarterial extracorporeal membrane oxygenation (VA ECMO) is an effective mechanical circulatory support for cardiopulmonary failure. Conventionally, an arterial cannula over 15 Fr is inserted for full circulatory support in peripheral VA ECMO. However, limited data are available regarding the impact of cannula size on clinical and procedural outcomes. Between January 2014 and April 2016, 165 patients underwent peripheral VA ECMO with femoral artery cannulation were enrolled in a single-center registry. We classified patients into two groups according to the arterial cannula’s size: “small cannula group” (14–15 Fr, n = 87) and “large cannula group” (16–21 Fr, n = 78). We compared the clinical outcomes and procedural-related complications between the two groups. Neither the survival to discharge (51.7% in the small cannula group vs. 57.7% in the large cannula group; p = 0.44) nor the weaning success rate (70.1% vs. 64.1%; p = 0.41) was significantly different between the two groups. There was no significant difference in initial ECMO flow/body surface area between the two groups (1.86 ± 0.42 vs. 1.98 ± 0.49 L/min/m2; p = 0.12) although small cannula group had a numerically low value. The small cannula group showed significantly shorter ECMO duration time (2.6 [0.7–5.2] vs. 4.0 [1.3–7.8] day; p < 0.01). Also, lower limb ischemia was significantly lower in the small cannula group (4.6% vs. 15.4%; p = 0.02). In peripheral VA ECMO, as compared with the large cannula strategy, the small arterial cannula strategy showed similar clinical outcomes and a decrease in lower limb ischemia.

From the *Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

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Submitted for consideration October 2017; accepted for publication in revised formJune 2018.

Disclosure: The authors have no conflicts of interest to report.

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Correspondence: Jeong Hoon Yang, Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea. Email: jhysmc@gmail.com.

Copyright © 2019 by the American Society for Artificial Internal Organs