Perclose ProGlide closure devices vs. surgical removal for veno-arterial extracorporeal membrane oxygenation decannulation: a meta-analysis.

Abstract

Objective: Perclose ProGlide closure devices (PPCDs) have become a more commonly used strategy in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) decannulation, but there is still uncertainty regarding their efficacy and safety compared to surgical removal (SR). Therefore, we conducted a meta-analysis to compare the application results of the two methods in VA-ECMO decannulation.

Methods: Data from PubMed, Cochrane Library, and EMBASE databases were systematically searched through May 2024. Prospective or retrospective studies on the comparison of PPCDs and SR in VA-ECMO decannulation were included. The outcomes included technical success, bleeding events, infections at the decannulation site, vascular complications, overall complications, mortality and duration of hospitalisation.

Results: Eight retrospective studies involving 618 patients were included. The results demonstrated that PPCDs significantly reduced infections at the decannulation site and overall complications [odds ratio (OR) = 0.14, 95% confidence interval (CI) 0.05-0.44, P < 0.001], (OR = 0.27, 95% CI 0.16-0.48, P < 0.001). No significant differences were observed in the incidence rates of bleeding events, vascular complications, mortality and duration of hospitalisation between the two groups (P > 0.05). Subgroup analysis revealed that the SR group had a significantly higher risk of the removal site infection compared to the percutaneous pre-closure group (OR = 0.06, 95% CI 0.01-0.29, P = 0.0003).

Conclusion: Pre-closure techniques utilizing PPCDs demonstrate a significant advantage over SR in reducing the overall incidence of complications for VA-ECMO decannulation, particularly in terms of reducing infections at the decannulation site.