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Published on: August 16, 2021
Percutaneous circulatory assistance in an interventional cardiology centre without on-site cardiac surgery
Ibrahim Hatoum1, Paul Luporsi2, Philippe Riccini2
1Department of Cardiology, Antibes Hospital Centre, 06600 Antibes, France.
Insights
Percutaneous extracorporeal membrane oxygenation (ECMO) is safe when performed by trained cardiologists without surgery, even in remote locations. This approach can improve survival for patients needing advanced cardiac support far from specialized centers.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Critical Care Medicine
Background:
- Percutaneous extracorporeal membrane oxygenation (ECMO) has advanced with improved cannulation techniques.
- The absence of on-site cardiac surgery necessitates evaluation of remote ECMO programs.
- Corsica, a French island, lacks an on-site cardiac surgery department.
Purpose of the Study:
- To evaluate the safety and efficacy of a percutaneous ECMO program in Corsica.
- Assess the feasibility of ECMO implantation without on-site surgical support.
- Determine outcomes of percutaneous cannulation in a remote setting.
Main Methods:
- A retrospective analysis of all patients receiving ECMO at Bastia Hospital Centre from January 2016 to April 2022.
- Inclusion of 39 patients who underwent ECMO implantation.
- Detailed review of cannulation techniques, including ultrasound and fluoroscopy guidance.
Main Results:
- ECMO was implanted in 39 patients (mean age 52.7 years, 84.6% male).
- Percutaneous cannulation with ultrasound guidance was highly successful (100%) with minimal immediate complications (similar to large trials).
- 51.3% of patients were transferred to referral centers post-cannulation, demonstrating successful initial stabilization.
Conclusions:
- Percutaneous ECMO performed by interventional cardiologists without a surgical team is safe.
- Widespread adoption of percutaneous cannulation can improve survival for patients distant from cardiac surgery centers.
- The study supports the expansion of remote percutaneous ECMO programs.
Background:
Percutaneous extracorporeal membrane oxygenation (ECMO) has been developed thanks to the progress in the field of cannulation, but still justifies the presence of an on-site cardiac resuscitation department. Corsica is a French island without an on-site cardiac surgery department.
Aim:
To evaluate the percutaneous ECMO programme in Corsica.
Methods:
All patients who received ECMO at the Bastia Hospital Centre between 01 January 2016 and 30 April 2022 were included.
Results:
ECMO was implanted in 39 patients. The mean age was 52.7years, with male predominance (84.6%). The majority of veno-arterial ECMOs were placed in the coronary angiography laboratory, whereas venovenous ECMOs were preferentially placed in the medical intensive care unit. Twenty patients (51.3%) were medically transferred to other referral centres after canulation. Percutaneous vascular cannulation was performed with ultrasound guidance in all cases (100%), and was successfully performed without immediate complications in all patients except two (who presented an immediate complication during cannulation), which is similar to large trials, despite the absence of on-site cardiac surgery. The use of ultrasound guidance (and sometimes fluoroscopy guidance) during cannulation and the experience of the medical team facilitated control over correct positioning of the cannulas and decreased implantation failure, without the need for a surgical approach.
Conclusions:
Percutaneous ECMO by trained interventional cardiologists without a surgical approach appears to be safe. Widespread use of percutaneous cannulation without cardiac surgery would increase survival for some patients who are far from these centres.
