Assessment of percutaneous closure for decannulation of veno-arterial extracorporeal membrane oxygenation: A retrospective study.

Abstract

Background: Despite the evidence supporting the use of Perclose Proglide^® (PP) suture-mediated vascular closure devices in various clinical scenarios, limited evidence exists regarding its role in percutaneous arterial closure of the femoral artery after venoarterial extracorporeal membrane oxygenation (VA-ECMO). Compared to conventional methods, this study evaluates the effectiveness and complications of bedside percutaneous femoral artery closure using Perclose ProGlide (PP) for VA-ECMO decannulation.

Methods: Retrospective cohort of consecutive patients managed with mechanical circulatory support VA-ECMO for refractory cardiogenic shock, who survived decannulation between January 2017 and August 2023. A comparison between PP and other decannulation strategies was established to evaluate the effectiveness and procedure-related complications of bedside percutaneous femoral artery closure using a PP with a post-closure technique compared to conventional approaches of surgical and manual decannulation.

Results: Among 122 patients decannulated from VA-ECMO with a mean age of 48.6 ± 13.1 and 78 (63.9) males, 49.2% comprised the PP group. Despite the older age (p = 0.021) and higher prevalence of arterial hypertension (p = 0.045), the PP group had a larger number of patients free from decannulation-related adverse events. Additionally, a higher haemoglobin level 24 h post decannulation (p = 0.047), with no difference in terms of transfusion of red blood cells between groups (p = 0.263) was found. The pseudoaneurysm was the most frequently reported complication, while the arterial cannulation surgical wound site infection was only documented in the open repair subgroup. A trend towards reduced Intensive Care (ICU) and hospital length of stay after decannulation was noted, although it did not reach statistical significance. There was no difference in mortality between both groups and no procedure-related deaths occurred. A mean of 2.7 PP devices were required to achieve complete haemostasis in the PP cohort, where technical failure was documented in four cases (6.7%).

Conclusions: Bedside Percutaneous decannulation of VA-ECMO using a PP device with a post-closure technique is safe and reliable for achieving effective haemostasis, with fewer vascular complications than conventional approaches and a low device failure rate.