Wound Complications Following Veno-arterial Ecmo Decannulation Is Associated With COVID-19 Infection And Ipsilateral Dual Cannulation

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a well-established tool for treatment of cardio-pulmonary collapse. The use of large bore cannulas in the femoral vessels for an extended period of time has been associated with significant wound complications. There is a lack of data analyzing risk factors related to these complications. The primary purpose of this study was to identify modifiable risk factors to reduce wound complication after VA ECMO decannulation. This is a retrospective cohort study from a single academic institution. Wound complications in patients following VA ECMO decannulation from 2014 to 2021 were studied. Wound complications were defined as wound dehiscence or those that had wounds that were deliberately opened to promote healing by secondary intention. Sixty patients underwent decannulation of VA ECMO with operative repair of the femoral artery. Fifteen patients were identified to have wound complications. The treatment consisted of local wound care in seven patients (46.7%), surgical debridement in seven patients (46.7%), and muscle flap in one patient (6.7%). In the univariate analysis, there is some correlation to wound complications with higher body mass index (28.3 vs 32.7 kg/m2; P = .110) and some association with COVID-19 infection (6.7% vs 26.7%; P = .058). Patients with the arterial and venous cannulas in the same groin had significantly more wound complications (57.8% vs 93.3%; P = .012) compared with single cannulation arterial and venous cannulas in separate groins. Multivariate analysis revealed same side cannulation (odds ratio, 18.05; 95% confidence interval, 1.44-226.18; P = .025) and COVID-19 infection (odds ratio, 18.18; 95% confidence interval, 1.50-220.66; P = .023) were independent predictors of wound complications. Wound complications after VA ECMO decannulation are associated with COVID-19 infection and having both arterial and venous cannulas in the same groin. We recommend that the arterial and venous cannulation be placed in contralateral groins in patients that require VA ECMO.