Percutaneous angio-guided versus surgical veno-arterial ECMO implantation in patients with cardiogenic shock or cardiac arrest

Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) has gained increasing place into the management of patients with refractory cardiogenic shock or cardiac arrest. Although surgical approach is the reference for ECMO insertion, percutaneous approach has been associated with fewer complications. Angio-guided percutaneous implantation and explantation may further decrease the rate of complication. We aimed to compare outcome and complication rates in patients supported with VA-ECMO through percutaneous angio-guided versus surgical approach. We included all patients with emergent peripheral femoro-femoral VA-ECMO implantation for refractory cardiogenic shock or cardiac arrest in our center from March 2018 to March 2021. Survival and major complications (major bleeding, limb ischemia and groin infection) rates were compared between the percutaneous angio-guided and the surgical groups. One hundred twenty patients received VA-ECMO, 59 through surgical approach and 61 through angio-guided percutaneous approach. Patients’ baseline characteristics and severity scores were equally balanced between the 2 groups. Thirty-day mortality was not significantly different between the 2 approaches. However, angio-guided percutaneous insertion was associated with fewer major vascular complications (42% vs. 11%, P > 0.0001) and a higher rate of ECMO explantation. In multivariate analysis, percutaneous angio-guided implantation of ECMO was independently associated with a lower probability of major complications. Compared to surgical approach, angio-guided percutaneous VA-ECMO implantation is associated with fewer major vascular complications. Large prospective randomized clinical trials are needed to confirm those results and address their impact on mortality.