Percutaneous decannulation reduces procedure length and rates of groin wound infection in patients on venoarterial extracorporeal membrane oxygenationCentral MessagePerspective
Sophia H. Roberts, MD,
Erin M. Schumer, MD,
Mary Sullivan, AGACNP-BC,
John Grotberg, MD,
Bianca Jenkins, BSN,
Irene Fischer, MPH,
Marci Damiano, BSN,
Matthew R. Schill, MD,
Muhammad F. Masood, MD,
Kunal Kotkar, MD,
Amit Pawale, MD
Affiliations
Sophia H. Roberts, MD
Division of Cardiac Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Mo
Erin M. Schumer, MD
Division of Cardiac Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Mo
Mary Sullivan, AGACNP-BC
Division of Cardiac Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Mo
John Grotberg, MD
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Mo
Bianca Jenkins, BSN
Division of Cardiac Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Mo
Irene Fischer, MPH
Division of Cardiac Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Mo
Marci Damiano, BSN
Division of Cardiac Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Mo
Matthew R. Schill, MD
Division of Cardiac Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Mo
Muhammad F. Masood, MD
Division of Cardiac Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Mo
Kunal Kotkar, MD
Division of Cardiac Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Mo
Amit Pawale, MD
Division of Cardiac Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Mo
Objective: Open decannulation from femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) carries high risk of morbidity, including groin wound infection. This study evaluated the impact of percutaneous decannulation on rates of groin wound infection in patients decannulated from femoral VA-ECMO. Methods: Between January 1, 2022, and April 30, 2023, 47 consecutive patients received percutaneous femoral VA-ECMO and survived to decannulation. A percutaneous suture-mediated closure device was used for decannulation in patients with relatively smaller arterial cannulas. Patients with larger arterial cannulas or unsuccessful percutaneous closures underwent surgical cutdown and repair of the femoral artery. The primary outcome was arterial site wound infection following decannulation. Results: Among the 47 patients who survived to decannulation from VA-ECMO, 21 underwent percutaneous decannulation and 27 underwent surgical cutdown. One patient underwent 2 VA-ECMO runs, one with percutaneous decannulation and one with surgical cutdown. Percutaneous decannulation was attempted in 22 patients, with 21 of 22 (95.5%) success rate. Decannulation procedure length was significantly shorter in the percutaneous group (79 minutes vs 148 minutes, P = .0001). The percutaneous group had significantly reduced rates of groin wound complications (0% vs 40.7%, P = .001) and groin wound infections (0% vs 22.2%, P = .03) when compared with the surgical cutdown group. Three patients (14.3%) in the percutaneous group experienced vascular complications, including pseudoaneurysm at the distal perfusion catheter site and nonocclusive thrombus of the common femoral artery. Conclusions: Percutaneous decannulation may reduce decannulation procedure length and rate of groin wound infection in patients who survive to decannulation from VA-ECMO.
