The following is a summary of “Outcomes With Single-Site Dual-Lumen Versus Multisite Cannulation for Adults With COVID-19 Respiratory Failure Receiving Venovenous Extracorporeal Membrane Oxygenation,” published in the August 2023 issue of Critical Care by O’Gara et al.
Researchers conducted a retrospective study to compare the outcomes of venovenous extracorporeal membrane oxygenation (VV-ECMO) patients treated with multisite versus single-site dual-lumen (SSDL) cannulation.
They analyzed the Extracorporeal Life Support Organization Registry. Propensity score matching (2:1 multisite vs. SSDL) was utilized to control for confounding. The matched cohort comprised 2,628 patients (1,752 multisite, 876 SSDL) from 170 centers. The mean age in the entire cohort was 48 (11) years, with 3,909 (71%) male. Patients received mechanical ventilation for a median duration of 79 (113) hours before VV-ECMO support. The primary outcome was 90-day survival. Secondary outcomes were survival to hospital discharge, ECMO duration, days free of ECMO at 90 days, and complication rates.
The results showed no differences in 90-day survival (49.4% vs. 48.9%, P= 0.66), survival to hospital discharge (49.8% vs. 48.2%, P=0.44), duration of ECMO support (17.9 vs. 17.1 days, P=0.82), or hospital length of stay after cannulation (28 days vs. 27.4 days, P=0.37) between the multisite and SSDL groups. More SSDL patients were extubated within 24 hours (4% vs. 1.9%, P=0.001). Multisite patients had higher ECMO flows at 24 hours (4.5 vs. 4.1 L/min, P<0.001) and more ECMO-free days at 90 days (3.1 vs. 2.0 days, P=0.02). SSDL patients had higher rates of pneumothorax (13.9% vs. 11%, P=0.03), while cannula site bleeding (6.4% vs. 4.7%, P=0.03), oxygenator failure (16.7% vs. 13.4%, P=0.03), and circuit clots (5.5% vs. 3.4%, P=0.02) were more common in multisite patients.
They concluded that multisite and SSDL cannulation strategies for COVID-19 ECMO have similar 90-day survival and complication rates.