Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Differences in Treatment Outcomes According to the Insertion Method Used in Extracorporeal Cardiopulmonary Resuscitation: A Single-Center Experience

  • Han Sol Lee (Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine) ;
  • Chul Ho Lee (Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine) ;
  • Jae Seok Jang (Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine) ;
  • Jun Woo Cho (Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine) ;
  • Yun-Ho Jeon (Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine)
  • Received : 2023.08.22
  • Accepted : 2024.01.18
  • Published : 2024.05.05
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Abstract

Background: Venoarterial extracorporeal membrane oxygenation (ECMO) is a key treatment method used with patients in cardiac arrest who do not respond to medical treatment. A critical step in initiating therapy is the insertion of ECMO cannulas. Peripheral ECMO cannulation methods have been preferred for extracorporeal cardiopulmonary resuscitation (ECPR). Methods: Patients who underwent ECPR at Daegu Catholic University Medical Center between January 2017 and May 2023 were included in this study. We analyzed the impact of 2 different peripheral cannulation strategies (surgical cutdown vs. percutaneous cannulation) on various factors, including survival rate. Results: Among the 99 patients included in this study, 66 underwent surgical cutdown, and 33 underwent percutaneous insertion. The survival to discharge rates were 36.4% for the surgical cutdown group and 30.3% for the percutaneous group (p=0.708). The ECMO insertion times were 21.3 minutes for the surgical cutdown group and 10.3 minutes for the percutaneous group (p<0.001). The factors associated with overall mortality included a shorter low-flow time (hazard ratio [HR], 1.045; 95% confidence interval [CI], 1.019-1.071; p=0.001) and whether return of spontaneous circulation was achieved (HR, 0.317; 95% CI, 0.127-0.787; p=0.013). Low-flow time was defined as the time from the start of cardiopulmonary resuscitation to the completion of ECMO cannula insertion. Conclusion: No statistically significant difference in in-hospital mortality was observed between the surgical and percutaneous groups. However, regardless of the chosen cannulation strategy, reducing ECMO cannulation time was beneficial, as a shorter low-flow time was associated with significant benefits in terms of survival.

Keywords

Acknowledgement

This work was supported by grant from the Korean Association of Mechanical Life Support (KAMEL 2024-002).

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