Comparison of Central and Peripheral Extracorporeal Membrane Oxygenation Cannulation Strategies in Postcardiotomy Shock.

OBJECTIVE

Compare in-hospital mortality and complication rates between central and peripheral extracorporeal membrane oxygenation (ECMO) cannulation in adult patients with postcardiotomy shock.

DESIGN

Retrospective observational study.

SETTING

Tertiary academic center.

PARTICIPANTS

Adult patients who received ECMO due to failure to wean from cardiopulmonary bypass or with cardiogenic shock or cardiac arrest <24 hours after weaning from cardiopulmonary bypass from 2010 to 2023.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

Patients were grouped by cannulation type: central (n = 241) and peripheral (n = 78). Primary outcomes were in-hospital mortality, bleeding requiring reoperation, stroke, limb ischemia, mechanical ventilation >7 days, and sepsis. Stabilized inverse probability of treatment weighting based on propensity scores was used to adjust baseline differences. Median age was 68.5 years, and 37.3% were female. Peripheral ECMO was associated with higher left ventricular ejection fraction (p = 0.016) and posttransplant indication (p = 0.026). Baseline imbalances were satisfactorily corrected after inverse probability of treatment weighting. After propensity score weighting, there were no significant differences in in-hospital mortality (49.8% v 44.5%, p = 0.416) or the other primary outcomes.

CONCLUSION

Central and peripheral ECMO cannulation showed no significant differences in in-hospital mortality or major complications. ECMO cannulation strategy should be guided by patient condition and institutional expertise.