Journal of cardiothoracic and vascular anesthesia · 2026
Percutaneous Decannulation Versus Open Surgical Decannulation in Patients Weaned From Venoarterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Motawea Karam R, Qadri Maria, Ibrahim Momen, Abouelenien Merna, El Diasty Mohammad, Abu-Omar Yasir, Pelletier Marc
Аннотация
OBJECTIVES: To compare clinical outcomes between percutaneous decannulation and conventional open surgical decannulation in patients undergoing femoral venoarterial (VA) extracorporeal membrane oxygenation (ECMO).
DESIGN AND SETTING: A systematic review and meta-analysis were conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PubMed, Web of Science, and Scopus databases were searched through January 2025 for randomized controlled trials and/or cohort studies comparing the two techniques in patients undergoing femoral VA ECMO.
PARTICIPANTS: Only studies comparing percutaneous decannulation and conventional open surgical decannulation in adult populations undergoing femoral VA ECMO were included. Thirteen cohort studies with 1,709 patients were included in this meta-analysis.
INTERVENTIONS: Percutaneous decannulation and conventional open surgical decannulation in patients undergoing femoral VA ECMO.
MEASUREMENTS AND MAIN RESULTS: Primary outcomes included mortality and procedural success. Secondary outcomes were vascular complications, wound complications, hospital and intensive care unit length of stay, and units of red blood cell transfusion. The pooled analysis revealed no significant difference between percutaneous decannulation and open surgical conventional approaches in terms of 30-day mortality (risk ratio [RR] = 0.78, 95% confidence interval [CI] [0.59-1.04], p-value = 0.09) or procedural success (RR = 0.98, 95% CI [0.93-1.04], p-value = 0.51). The pooled effect estimate showed a significant association between percutaneous decannulation and decreased wound infection rate (RR = 0.26, 95% CI [0.14-0.48], p-value < 0.0001), delayed wound healing (RR = 0.03, 95% CI [0.0-0.24], p-value = 0.0008), open revision (RR = 0.52, 95% CI [0.28-0.95], p-value = 0.03), and amount of red blood cell transfusion (MD = -0.34 [-0.60, -0.09], p-value = 0.008) compared with the open surgical conventional approach. However, the study revealed no significant differences between the percutaneous and conventional open surgical decannulation approaches in vascular and wound complications, or in the length of intensive care unit and hospital stays.
CONCLUSION: The study suggests no significant difference between the percutaneous and open surgical decannulation approaches in patients undergoing femoral VA ECMO with respect to 30-day mortality and procedural success. However, the percutaneous approach is associated with better results than the conventional open surgical approach, given its potential to decrease infection rates, delayed wound healing, open revision, and blood transfusions. Multicenter randomized controlled trials are warranted to confirm these findings.
DESIGN AND SETTING: A systematic review and meta-analysis were conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PubMed, Web of Science, and Scopus databases were searched through January 2025 for randomized controlled trials and/or cohort studies comparing the two techniques in patients undergoing femoral VA ECMO.
PARTICIPANTS: Only studies comparing percutaneous decannulation and conventional open surgical decannulation in adult populations undergoing femoral VA ECMO were included. Thirteen cohort studies with 1,709 patients were included in this meta-analysis.
INTERVENTIONS: Percutaneous decannulation and conventional open surgical decannulation in patients undergoing femoral VA ECMO.
MEASUREMENTS AND MAIN RESULTS: Primary outcomes included mortality and procedural success. Secondary outcomes were vascular complications, wound complications, hospital and intensive care unit length of stay, and units of red blood cell transfusion. The pooled analysis revealed no significant difference between percutaneous decannulation and open surgical conventional approaches in terms of 30-day mortality (risk ratio [RR] = 0.78, 95% confidence interval [CI] [0.59-1.04], p-value = 0.09) or procedural success (RR = 0.98, 95% CI [0.93-1.04], p-value = 0.51). The pooled effect estimate showed a significant association between percutaneous decannulation and decreased wound infection rate (RR = 0.26, 95% CI [0.14-0.48], p-value < 0.0001), delayed wound healing (RR = 0.03, 95% CI [0.0-0.24], p-value = 0.0008), open revision (RR = 0.52, 95% CI [0.28-0.95], p-value = 0.03), and amount of red blood cell transfusion (MD = -0.34 [-0.60, -0.09], p-value = 0.008) compared with the open surgical conventional approach. However, the study revealed no significant differences between the percutaneous and conventional open surgical decannulation approaches in vascular and wound complications, or in the length of intensive care unit and hospital stays.
CONCLUSION: The study suggests no significant difference between the percutaneous and open surgical decannulation approaches in patients undergoing femoral VA ECMO with respect to 30-day mortality and procedural success. However, the percutaneous approach is associated with better results than the conventional open surgical approach, given its potential to decrease infection rates, delayed wound healing, open revision, and blood transfusions. Multicenter randomized controlled trials are warranted to confirm these findings.