Outcomes of Subclavian Vein Cannulation in Venovenous Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Study.

Abstract

Objective: Venovenous (VV) extracorporeal membrane oxygenation (ECMO) cannulation may pose venous access challenges. Subclavian vein (SCV) cannulation is an alternative site. This study hypothesizes that SCV access is a safe alternative in VV ECMO.

Methods: This is a single-center, retrospective study of peripheral VV ECMO that was stratified by SCV cannulation. Each site was considered as a separate cannulation event. Descriptive statistics, groupwise comparisons, and mixed-effects logistic regression were used. Primary endpoints included cannulation-specific complications and ECMO-related adverse events.

Results: From 2020 to 2023, 157 patients were supported with VV ECMO. The cohort was 57% male patients with a median age of 44 (34 to 56) years and a median body mass index of 34 (28 to 44) kg/m². Thirty-five percent of patients (n = 55) had an SCV cannula during their ECMO course. Both groups had similar pre-ECMO variables, except for higher rates of COVID-19 (69% [n = 38] vs 49% [n = 49], P = 0.016) in the SCV cohort. There was no unadjusted survival difference (P = 0.8). There were 392 unique cannulation events. SCV cannulations were more commonly employed for additional cannulas and transitioning to single-site dual-lumen cannulation (P < 0.001). There was an increased cannulation-associated pneumothorax rate in the SCV arm (P < 0.001) when compared with all non-SCV sites. Mixed-effects logistic regression showed no site-related differences in adverse events or complication rates.

Conclusions: Between the SCV and non-SCV groups, there was no difference in site-related adverse events or complications. This study supports the use of SCV cannulation as a viable alternative in patients supported with VV ECMO.