Percutaneous circulatory assistance in an interventional cardiology centre without on-site cardiac surgery.

Abstract

Background: Percutaneous extracorporeal membrane oxygenation (ECMO) has been developed thanks to the progress in the field of cannulation, but still justifies the presence of an on-site cardiac resuscitation department. Corsica is a French island without an on-site cardiac surgery department.

Aim: To evaluate the percutaneous ECMO programme in Corsica.

Methods: All patients who received ECMO at the Bastia Hospital Centre between 01 January 2016 and 30 April 2022 were included.

Results: ECMO was implanted in 39 patients. The mean age was 52.7years, with male predominance (84.6%). The majority of veno-arterial ECMOs were placed in the coronary angiography laboratory, whereas venovenous ECMOs were preferentially placed in the medical intensive care unit. Twenty patients (51.3%) were medically transferred to other referral centres after canulation. Percutaneous vascular cannulation was performed with ultrasound guidance in all cases (100%), and was successfully performed without immediate complications in all patients except two (who presented an immediate complication during cannulation), which is similar to large trials, despite the absence of on-site cardiac surgery. The use of ultrasound guidance (and sometimes fluoroscopy guidance) during cannulation and the experience of the medical team facilitated control over correct positioning of the cannulas and decreased implantation failure, without the need for a surgical approach.

Conclusions: Percutaneous ECMO by trained interventional cardiologists without a surgical approach appears to be safe. Widespread use of percutaneous cannulation without cardiac surgery would increase survival for some patients who are far from these centres.