SPC365

Evaluating the outcomes of bedside percutaneous peripheral VA-ECMO decannulation using a Perclose ProGlide suture-mediated post-closure procedure in a high-volume ECMO centre

Session: Comunicações Orais - Sessão 14 - Choque cardiogénico e suporte circulatório mecânico
Speaker: Diana Patrícia Martins Fernandes

Congress: CPC 2024
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type: Comunicações Orais
FP Number: ---
Authors: Diana Martins Fernandes; Rita Ferreira; Hélio Martins; João Neves; Sérgio Gaião; José Artur Paiva

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Introduction</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt">Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) offers mechanical circulatory support for cardiac arrest and cardiogenic shock with potentially reversible causes. Despite its expanding role, decannulation carries high risk of vascular complications and the available guidance is scarce. While the Perclose ProGlide technique <span style="background-color:white"><span style="color:#222731">is safe and efficacious for endovascular surgery and cardiac catheterization, its role in VA-ECMO </span></span>decannulation remains controversial. &nbsp;&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Methods</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt">Single-centre retrospective cohort study assessing ProGlide-based post-closure decannulation from VA-ECMO compared with conventional strategies, including manual compression or surgical repair. Eligible patients included adults, decannulated from VA-ECMO, at a Portuguese ELSO Centre, from January 2017 to August 2023. Depending on physician skill, ProGlide technique is preferred in the absence of bleeding history and coagulopathy, with shorter VA-ECMO lifespan. Primary outcome was decannulation-related complications. Secondary outcomes were hospital and intensive care unit (ICU) length of stay, procedural success, need of surgical repair and 30-day post-ICU mortality.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Results</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt">During the study period 120 patients met the inclusion criteria. The ProGlide group comprised 59 patients (49%) and the conventional group 61 (51%). Baseline characteristics were similar between groups. VA-ECMO was mainly used for post-acute myocardial infarction cardiogenic shock (22.5%) and most cannulations occurred in the ICU setting (41.7%) and emergency department (30.8%). Median VA-ECMO duration was 14.8 (IQR 13.6) days, with the ProGlide group spending less time on ECMO (p = 0.014, modified T test). Most patients were decannulated after cardiac function recovery (85%) and 12.5% after cardiac transplantation. 48 complications were documented, mainly pseudoaneurysm (19.2%) and limb ischaemia (10%). Decannulation using ProGlide technique resulted in fewer complications compared to conventional approaches (p = 0.001, Pearson Chi-Square Test) and a lower risk of vascular complications (OR 0.606). Emergency VA-ECMO canulation correlates with more decannulation complications (p = 0.03, Pearson Chi-Square Test). ProGlides were efficient in 93.2% of cases, with a mean of 3 (SD &plusmn; 1) ProGlide devices for procedural success. Despite not reaching statistical significance, the ProGlide approach was associated with shorter ICU and hospital length of stay, both overall and after decannulation. No differences between groups were found in terms of mortality and need for surgical repair of complications. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Conclusion</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt">The results showed the ProGlide-based post-closure technique for VA-ECMO decannulation is feasible, safe, and effective, with <span style="background-color:white"><span style="color:#222731">high technical success rate and fewer procedure-related adverse events. Furthermore, a trend towards reduced </span></span>ICU and hospital length of stay was observed. </span></span></span></p>