Percutaneous Versus Surgical Cannulation for Veno-Arterial Extracorporeal Life Support: A Systematic Review and Meta-Analysis.

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.