Health science reports · 2026
Percutaneous Versus Surgical Cannulation for Veno-Arterial Extracorporeal Life Support: A Systematic Review and Meta-Analysis.
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Sami Syeda Zuha, Nazir Ariba, Murtaza Muzna, Hanif Zainab Muhammad, Khurram Laiba, Iman Aghna, Ahmed Muhammad, Okon Inibehe Ime
Аннотация
BACKGROUND AND AIMS: Extracorporeal life support (ECLS) is a critical intervention in the management of severe cardiac and respiratory failure. Among the commonly used cannulation techniques, percutaneous cannulation (PC) and surgical cannulation (SC) are most prevalent; however, their comparative safety and effectiveness remain under debate. The aim of this systematic review and meta-analysis was to evaluate and compare the clinical outcomes associated with PC and SC in patients undergoing veno-arterial ECLS.
METHOD: A comprehensive literature search was conducted in PubMed, Google Scholar, and the Cochrane Library to identify relevant studies. Six studies with a total of 13,744 patients (9962 PC and 3782 SC) met the inclusion criteria. Data extraction and analysis were performed using RevMan software, applying a random-effects model. Meta-regression and sensitivity analyses were also performed to evaluate heterogeneity. Dichotomous outcomes were assessed using relative risk (RR) with 95% confidence intervals (CIs), and continuous outcomes using mean differences (MDs) with 95% CIs. Statistical significance was set at p ≤ 0.05.
RESULTS: PC was associated with a significantly lower risk of cannulation site infections (RR: 0.56, 95% CI: 0.41-0.78, p = 0.0005). A trend toward fewer vascular complications was also observed with PC compared to SC (RR: 0.48, 95% CI: 0.23-1.00, p = 0.05). Secondary outcomes, including in-hospital mortality, duration of ECLS, renal replacement therapy, weaning success, limb ischemia, fasciotomy, and amputation, showed mixed or inconclusive findings.
CONCLUSION: Compared with SC, PC appears to reduce the risk of infections and vascular complications in veno-arterial ECLS patients. However, further high-quality studies are required to establish its benefits across other clinical outcomes.
METHOD: A comprehensive literature search was conducted in PubMed, Google Scholar, and the Cochrane Library to identify relevant studies. Six studies with a total of 13,744 patients (9962 PC and 3782 SC) met the inclusion criteria. Data extraction and analysis were performed using RevMan software, applying a random-effects model. Meta-regression and sensitivity analyses were also performed to evaluate heterogeneity. Dichotomous outcomes were assessed using relative risk (RR) with 95% confidence intervals (CIs), and continuous outcomes using mean differences (MDs) with 95% CIs. Statistical significance was set at p ≤ 0.05.
RESULTS: PC was associated with a significantly lower risk of cannulation site infections (RR: 0.56, 95% CI: 0.41-0.78, p = 0.0005). A trend toward fewer vascular complications was also observed with PC compared to SC (RR: 0.48, 95% CI: 0.23-1.00, p = 0.05). Secondary outcomes, including in-hospital mortality, duration of ECLS, renal replacement therapy, weaning success, limb ischemia, fasciotomy, and amputation, showed mixed or inconclusive findings.
CONCLUSION: Compared with SC, PC appears to reduce the risk of infections and vascular complications in veno-arterial ECLS patients. However, further high-quality studies are required to establish its benefits across other clinical outcomes.