Outcomes by cannulation methods for venovenous extracorporeal membrane oxygenation during COVID-19: A multicenter retrospective study
Saeed O, Stein LH, Cavarocchi N, Tatooles AJ, Mustafa A, Jorde UP, Alvarez C, Gluck J, Saunders P, Abrol S, De Anda A Jr, Goldstein DJ, Silvestry S. Outcomes by Cannulation Methods for Venovenous Extracorporeal Membrane Oxygenation during COVID-19: A Multicenter Retrospective Study. Artif Organs. 2022 Feb 22. doi: 10.1111/aor.14213. Epub ahead of print. PMID: 35191553.
Purpose: To determine if a cannulation method for venovenous extracorporeal membrane oxygenation (V-V ECMO) is related to patient outcome.
Methods: A retrospective, multi-center study of adult patients (≥18 years old) placed on V-V ECMO for severe respiratory failure due to COVID-19 between March 1, 2020, to April 30, 2021. Patients were divided into the following 3 groups based on the initial cannulation method: 1) femoral vein-femoral vein or femoral vein-internal jugular vein (Dual-Site, C-DS), 2) single, dual-lumen cannula in internal jugular vein with tip positioned in the pulmonary artery (C-PA) and 3) single, dual-lumen cannula in internal jugular vein with tip positioned in the inferior vena cava (C-IVC). The primary outcome was in-hospital mortality assessed by a time-to-event analysis.
Results: Overall, 435 patients from 17 centers comprised the study cohort. C-DS was performed in 247 (57%, age: 49, IQR:39-57 years; 30% female) cases, 99 (23%, age: 53, IQR: 42-59 years; 26% female) received C-PA, and 89 (20%) patients got C-IVC (age: 46, IQR 35-54; 33% female). At 90-days, in-hospital mortality was 60% (C-DS), 41% (C-PA) and 61% (C-IVC), p=0.06. After adjustment for clinical characteristics, the likelihood of in-hospital mortality in comparison to C-DS, was lower with C-PA (aHR: 0.52, 95%CI 0.32-0.85, p=0.009) and similar with C-IVC (aHR: 0.96, 95%CI 0.63-1.47, p=0.86).
Conclusion: Catheter directed flow into the PA bypassing the right ventricle with a single dual-lumen cannula is associated with reduced mortality during V-V ECMO for COVID-19. These findings are limited by residual confounding and site-clustering. Further investigation is urgently warranted with randomized studies.