Right Axillary Artery Cannulation For Venoarterial Extracorporeal Membrane Oxygenation: A Retrospective Single Centre Observational Study

OBJECTIVES: Our goal was to assess the safety, outcomes and complication rate of axillary artery cannulation for venoarterial extracorporeal membrane oxygenation (VA-ECMO).METHODS: A retrospective analysis was conducted on data obtained from the review of medical charts of all consecutive patients undergoing VA-ECMO implantation between January 2013 and December 2017 at a teaching hospital. Only patients with right axillary VA-ECMO implantation in a non-emergency setting were included. Post-procedural outcomes and local and systemic complications were analysed.RESULTS: One hundred and seventy-four [131 male (75.3%), 43 female (24.7%); mean age 56.815.1years] patients underwent femoral-axillary VA-ECMO. Indications were cardiogenic shock from any cause (n=78, 44.8%) or post-cardiotomy syndrome (n=96, 55.2%). Fifty-three (30.5%) patients died while on VA-ECMO support. At the time of VA-ECMO ablation, 89 (51.1%) patients had recovered; 13 (7.5%) patients were bridged to a long-term mechanical support device and 19 (10.9%) patients underwent heart transplants. Thirty-day and 1-year mortality was 36.2% (n=63) and 49.4% (n=86), respectively. The 1-year survival rate of patients who were weaned from VA-ECMO support was 72.7% (n=88). The complications of axillary cannulation were bleeding (n=7, 4%), local infection (n=3, 1.7%), upper limb ischaemia (n=2, 1.1%) and brachial plexus injury (n=1, 0.6%). Left ventricle unloading was required for 9 (5.2%) patients. The median duration of VA-ECMO support was 7 (range 1-26) days.CONCLUSIONS: Right axillary artery cannulation is a safe and reliable method for VA-ECMO support with a low rate of local complications. In the absence of a control group with femoro-femoral cannulation, no definitive conclusion about the superiority of axillary over femoral cannulation can be drawn.