Success rate， complications and influencing factors of percutaneous ultrasound-guided extracorporeal membrane oxygenation （ECMO） puncture and catheterization: a single-center retrospective analysis

Abstract

Objective To investigate the success rate， complications and influencing factors of extracorporeal membrane oxygenation （ECMO） puncture and catheterization under ultrasound guidance. Methods Clinical cases of veno-arterial ECMO were collected. The success rate and incidence of complications of ultrasound-guided percutaneous catheterization were analyzed. Meantime， gender， age， cardiac function （ejection fraction （EF） < 30%/EF≥30%）， target artery diameter （< 5.0 mm/≥5.0 mm）， success of one-time puncture， hypertension and other variables were included. Univariate and/or multivariate logistic regression analyses were used to analyze the influencing factors of the overall success rate and complications of catheterization in extracorporeal cardiopulmonary resuscitation （ECPR） patients （ECPR group） and non-ECPR patients （non-ECPR group）. Results 65 cases of veno-arterial ECMO were included in the study， with an average age of （49.3±18.2） years. 23 cases were assigned in the ECPR group and 42 cases in the non-ECPR group. The overall success rate of ultrasound-guided ECMO catheterization was 86%， 78% in the ECPR group and 91% in non-ECPR group. 13 cases developed hematoma and 5 cases of distal limb ischemia after puncture.Logistic regression analyses showed that the target artery diameter and the success of one-time puncture were the influencing factors for the success rate of overall puncture and catheterization， and the success of one-time puncture was also the influencing factor for the incidence rate of hematoma （all P < 0.05）. In subgroup analysis， the diameter of target artery was found to be a factor affecting the success rate of puncture and catheterization in the ECPR group （P < 0.05）， whereas no statistically significant factor was found in the non-ECPR group （all P > 0.05）. Conclusions Percutaneous ultrasound-guided ECMO catheterization has a high success rate and safety. For non-ECPR patients and those with target artery diameter of ≥5 mm， percutaneous ultrasound-guided ECMO catheterization is the optimal option. Successful one-time puncture should be guaranteed， which can not only improve the success rate of final puncture and catheterization， but also reduce the incidence of hematoma.

Keywords

• |extracorporeal membrane oxygenation|puncture and catheterization|success rate|complication|influencing factor