Neurologic complications in patients receiving aortic versus subclavian versus femoral arterial cannulation for post-cardiotomy extracorporeal life support: results of the PELS observational multicenter study
Issued Date
2024-08-07
Resource Type
eISSN
1466609X
Scopus ID
2-s2.0-85200939207
Pubmed ID
39113082
Journal Title
Critical care (London, England)
Volume
28
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Critical care (London, England) Vol.28 No.1 (2024) , 265
Suggested Citation
Chiarini G., Mariani S., Schaefer A.K., van Bussel B.C.T., Di Mauro M., Wiedemann D., Saeed D., Pozzi M., Botta L., Boeken U., Samalavicius R., Bounader K., Hou X., Bunge J.J.H., Buscher H., Salazar L., Meyns B., Herr D., Matteucci S., Sponga S., Ramanathan K., Russo C., Formica F., Sakiyalak P., Fiore A., Camboni D., Raffa G.M., Diaz R., Wang I.W., Jung J.S., Belohlavek J., Pellegrino V., Bianchi G., Pettinari M., Barbone A., Garcia J.P., Shekar K., Whitman G.J.R., Lorusso R. Neurologic complications in patients receiving aortic versus subclavian versus femoral arterial cannulation for post-cardiotomy extracorporeal life support: results of the PELS observational multicenter study. Critical care (London, England) Vol.28 No.1 (2024) , 265. doi:10.1186/s13054-024-05047-2 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/100503
Title
Neurologic complications in patients receiving aortic versus subclavian versus femoral arterial cannulation for post-cardiotomy extracorporeal life support: results of the PELS observational multicenter study
Author(s)
Chiarini G.
Mariani S.
Schaefer A.K.
van Bussel B.C.T.
Di Mauro M.
Wiedemann D.
Saeed D.
Pozzi M.
Botta L.
Boeken U.
Samalavicius R.
Bounader K.
Hou X.
Bunge J.J.H.
Buscher H.
Salazar L.
Meyns B.
Herr D.
Matteucci S.
Sponga S.
Ramanathan K.
Russo C.
Formica F.
Sakiyalak P.
Fiore A.
Camboni D.
Raffa G.M.
Diaz R.
Wang I.W.
Jung J.S.
Belohlavek J.
Pellegrino V.
Bianchi G.
Pettinari M.
Barbone A.
Garcia J.P.
Shekar K.
Whitman G.J.R.
Lorusso R.
Mariani S.
Schaefer A.K.
van Bussel B.C.T.
Di Mauro M.
Wiedemann D.
Saeed D.
Pozzi M.
Botta L.
Boeken U.
Samalavicius R.
Bounader K.
Hou X.
Bunge J.J.H.
Buscher H.
Salazar L.
Meyns B.
Herr D.
Matteucci S.
Sponga S.
Ramanathan K.
Russo C.
Formica F.
Sakiyalak P.
Fiore A.
Camboni D.
Raffa G.M.
Diaz R.
Wang I.W.
Jung J.S.
Belohlavek J.
Pellegrino V.
Bianchi G.
Pettinari M.
Barbone A.
Garcia J.P.
Shekar K.
Whitman G.J.R.
Lorusso R.
Author's Affiliation
Korea University Anam Hospital
Siriraj Hospital
Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
National University Health System
Heinrich-Heine-Universität Düsseldorf Medizinische Fakultät
Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona
Fundación Cardiovascular de Colombia
Beijing Anzhen Hospital, Capital Medical University
CARIM School for Cardiovascular Disease
Ziekenhuis Oost-Limburg
Vilniaus Universitetas
Erasmus MC
UNSW Sydney
Hôpital Pontchaillou
St. Vincent's Hospital Sydney
KU Leuven
Humanitas Research Hospital
Indiana University-Purdue University Indianapolis
Hôpital Henri Mondor
Herzzentrum Leipzig
Klinikum der Universität Regensburg und Medizinische Fakultät
Clínica Las Condes
Charles University
Asst Grande Ospedale Metropolitano Niguarda
Policlinico Universitario, Udine
University of Maryland, Baltimore (UMB)
Spedali Civili Di Brescia
Medizinische Universität Wien
The Alfred
Azienda Ospedaliero-Universitaria di Parma
Memorial Healthcare System
The Prince Charles Hospital
The Johns Hopkins Hospital
Fondazione IRCCS San Gerardo dei Tintori
Karl Landsteiner University
Ospedale del Cuore Fondazione Toscana “G. Monasterio”
Louis Pradel Cardiologic Hospital
Division of Cardiac Surgery
Siriraj Hospital
Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
National University Health System
Heinrich-Heine-Universität Düsseldorf Medizinische Fakultät
Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona
Fundación Cardiovascular de Colombia
Beijing Anzhen Hospital, Capital Medical University
CARIM School for Cardiovascular Disease
Ziekenhuis Oost-Limburg
Vilniaus Universitetas
Erasmus MC
UNSW Sydney
Hôpital Pontchaillou
St. Vincent's Hospital Sydney
KU Leuven
Humanitas Research Hospital
Indiana University-Purdue University Indianapolis
Hôpital Henri Mondor
Herzzentrum Leipzig
Klinikum der Universität Regensburg und Medizinische Fakultät
Clínica Las Condes
Charles University
Asst Grande Ospedale Metropolitano Niguarda
Policlinico Universitario, Udine
University of Maryland, Baltimore (UMB)
Spedali Civili Di Brescia
Medizinische Universität Wien
The Alfred
Azienda Ospedaliero-Universitaria di Parma
Memorial Healthcare System
The Prince Charles Hospital
The Johns Hopkins Hospital
Fondazione IRCCS San Gerardo dei Tintori
Karl Landsteiner University
Ospedale del Cuore Fondazione Toscana “G. Monasterio”
Louis Pradel Cardiologic Hospital
Division of Cardiac Surgery
Corresponding Author(s)
Other Contributor(s)
Abstract
BACKGROUND: Cerebral perfusion may change depending on arterial cannulation site and may affect the incidence of neurologic adverse events in post-cardiotomy extracorporeal life support (ECLS). The current study compares patients' neurologic outcomes with three commonly used arterial cannulation strategies (aortic vs. subclavian/axillary vs. femoral artery) to evaluate if each ECLS configuration is associated with different rates of neurologic complications. METHODS: This retrospective, multicenter (34 centers), observational study included adults requiring post-cardiotomy ECLS between January 2000 and December 2020 present in the Post-Cardiotomy Extracorporeal Life Support (PELS) Study database. Patients with Aortic, Subclavian/Axillary and Femoral cannulation were compared on the incidence of a composite neurological end-point (ischemic stroke, cerebral hemorrhage, brain edema). Secondary outcomes were overall in-hospital mortality, neurologic complications as cause of in-hospital death, and post-operative minor neurologic complications (seizures). Association between cannulation and neurological outcomes were investigated through linear mixed-effects models. RESULTS: This study included 1897 patients comprising 26.5% Aortic (n = 503), 20.9% Subclavian/Axillary (n = 397) and 52.6% Femoral (n = 997) cannulations. The Subclavian/Axillary group featured a more frequent history of hypertension, smoking, diabetes, previous myocardial infarction, dialysis, peripheral artery disease and previous stroke. Neuro-monitoring was used infrequently in all groups. Major neurologic complications were more frequent in Subclavian/Axillary (Aortic: n = 79, 15.8%; Subclavian/Axillary: n = 78, 19.6%; Femoral: n = 118, 11.9%; p < 0.001) also after mixed-effects model adjustment (OR 1.53 [95% CI 1.02-2.31], p = 0.041). Seizures were more common in Subclavian/Axillary (n = 13, 3.4%) than Aortic (n = 9, 1.8%) and Femoral cannulation (n = 12, 1.3%, p = 0.036). In-hospital mortality was higher after Aortic cannulation (Aortic: n = 344, 68.4%, Subclavian/Axillary: n = 223, 56.2%, Femoral: n = 587, 58.9%, p < 0.001), as shown by Kaplan-Meier curves. Anyhow, neurologic cause of death (Aortic: n = 12, 3.9%, Subclavian/Axillary: n = 14, 6.6%, Femoral: n = 28, 5.0%, p = 0.433) was similar. CONCLUSIONS: In this analysis of the PELS Study, Subclavian/Axillary cannulation was associated with higher rates of major neurologic complications and seizures. In-hospital mortality was higher after Aortic cannulation, despite no significant differences in incidence of neurological cause of death in these patients. These results encourage vigilance for neurologic complications and neuromonitoring use in patients on ECLS, especially with Subclavian/Axillary cannulation.
