Venous or arterial thromboses after venoarterial extracorporeal membrane oxygenation support: Frequency and risk factors.

Abstract

BACKGROUND:

Although venous thrombosis after venovenous-extracorporeal membrane oxygenation (ECMO) is well described, vascular complications occurring after venoarterial ECMO (VA-ECMO) removal have not yet been thoroughly described. Our aim was to evaluate the frequency of vascular (arterial and venous) complications after VA-ECMO removal and try to identify the risk factors associated with them.

METHODS:

Retrospective analysis of data prospectively collected in 2 intensive care units was performed. Consecutive patients successfully weaned off VA-ECMO during year 1 were screened for cannula-associated deep vein thrombosis (CaDVT) or arterial complications (arterial thrombosis/stenosis) using Doppler ultrasonography.

RESULTS:

From November 2018 to November 2019, a total of 107 patients with a median (interquartile range [IQR]) age of 54 (42-63) years and a median (IQR) ECMO support duration of 8 (2-5) days were successfully weaned off VA-ECMO and included. CaDVT occurred in 44 patients (41%), and arterial complications occurred in 15 (14%) (9 acute leg ischemia, 1 arteriovenous femoral fistula, and 5 late femoral stenosis). Multivariable analysis retained longer duration of ECMO support (odds ratio [OR]: 1.12 per day; 95% CI: 1.02-1.22) and infection occurring on ECMO (OR: 3.03; 95% CI: 1.14-8.03) as independent risk factors for CaDVT, whereas older age (OR: 0.97 per year; 95% CI: 0.94-0.99) and previous anti-coagulation use (OR: 0.21; 95% CI: 0.06-0.68) were protective factors for CaDVT. No risk factors for arterial complications were identified.

CONCLUSIONS:

In patients requiring VA-ECMO support, vascular complications occurred frequently after its removal, especially CaDVT. Arterial complications, either early leg ischemia or late arterial stenosis, were observed less often. Strategies aimed at preventing CaDVT after VA-ECMO remain to be determined.

• Authors: Frank Bidar, Aymeric Lancelot, Guillaume Lebreton, Marc Pineton de Chambrun, Matthieu Schmidt, Guillaume Hékimian, Charles Juvin, Nicolas Bréchot, Thibaut Schoell, Pascal Leprince, Alain Combes, Adrien Bouglé, Charles-Edouard Luyt
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 40 Issue 4 Pg. 307-315 (04 2021) ISSN: 1557-3117 [Electronic] United States
• PMID: 33422407 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Extracorporeal Membrane Oxygenation (adverse effects)
• Female
• Femoral Artery
• Follow-Up Studies
• France (epidemiology)
• Humans
• Incidence
• Male
• Middle Aged
• Retrospective Studies
• Risk Assessment (methods)
• Risk Factors
• Thrombosis (diagnosis, epidemiology, etiology)
• Ultrasonography, Doppler
• Veins