The following is a summary of “Neurologic complications in patients receiving aortic versus subclavian versus femoral arterial cannulation for post-cardiotomy extracorporeal life support: results of the PELS observational multicenter study,” published in the August 2024 issue of Critical Care by Chiarini et al.
Arterial cannulation sites may impact cerebral infusion during post-cardiotomy extracorporeal life support (ECLS), influencing neurological complications.
Researchers conducted a retrospective study to compare neurologic outcomes in patients undergoing post-cardiotomy ECLS based on 3 arterial cannulation sites, aortic, subclavian/axillary, and femoral, to investigate ECLS configuration further.
They analyzed adults requiring post-cardiotomy ECLS present in the Post-Cardiotomy Extracorporeal Life Support (PELS) study database, which compared aortic, subclavian/axillary, and femoral cannulation for neurological outcomes such as stroke, hemorrhage, brain edema, secondary outcomes, in-hospital mortality, and postoperative seizures, with association of linear mixed-effects models.
The results showed 1,897 patients consisting of 26.5% aortic (n=503), 20.9% subclavian/axillary (n=397), and 52.6% femoral (n=997) cannulations. The subclavian/axillary group showed a higher rate of hypertension, smoking, diabetes, previous myocardial infarction, dialysis, peripheral artery disease, and stroke. Neuro-monitoring was commonly used in all groups. Major neurologic complications were most common in subclavian/axillary (Aortic: n=79, 15.8%; Subclavian/Axillary: n=78, 19.6%; Femoral: n=118, 11.9%; P<0.001) also after mixed-effects model adjustment (OR 1.53 [95% CI 1.02–2.31], P=0.041). Seizures were more frequent in subclavian/axillary (n=13, 3.4%) than in aortic (n=9, 1.8%) and femoral cannulation (n=12, 1.3%, P=0.036). In-hospital mortality was higher after aortic cannulation (Aortic: n=344, 68.4%, Subclavian/Axillary: n=223, 56.2%, Femoral: n=587, 58.9%, P < 0.001), as shown by Kaplan–Meier curves. Neurologic cause of death (Aortic: n=12, 3.9%, Subclavian/Axillary: n=14, 6.6%, Femoral: n=28, 5.0%, P=0.433) was similar.
They concluded that subclavian/axillary cannulation was linked to higher rates of major neurologic complications, while aortic cannulation had a higher in-hospital mortality rate.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05047-2
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