Vascular Closure Device vs Open Decannulation for Femoral Venoarterial Extracorporeal Membrane Oxygenation

Traditional decannulation of femoral venoarterial (VA) extracorporeal membrane oxygenation (ECMO) involves femoral cutdown. Percutaneous methods have been developed, but data supporting their use are limited. This study sought to compare the MANTA (Teleflex) vascular closure device with open decannulation.

The study investigators retrospectively reviewed patients decannulated from femoral VA ECMO from January 2018 to January 2023 at our institution (University of Maryland Medical Center, Baltimore, MD). Patients were excluded if cannulation was not percutaneous or if percutaneous decannulation was performed without MANTA use. The primary outcome was lower extremity complications. Closure of the distal perfusion site was compared between superficial femoral artery (SFA) manual pressure and percutaneous closure with MYNX (Cordis) or Angioseal (Terumo Medical Corporation).

A total of 160 patients underwent open decannulation, and 94 patients (30 at bedside) underwent MANTA decannulation. Both groups had 6-day median ECMO support duration. The intraoperative revision rate between MANTA and open decannulation was similar (9 [9.6%] vs 26 [16.4%]; P = .13). Four revisions for MANTA were technical failures in early surgeon experience. In a multivariable model, there was a 46% relative reduction in lower extremity complications with MANTA decannulation compared with open decannulation (26.1% vs 39.6%; odds ratio, 0.54; 95% CI, 0.28-1.00). There was no significant difference in SFA complications between manual pressure and percutaneous closure (14.4% vs 10.7%; odds ratio, 0.71; 95% CI, 0.29-1.76).

There is a significant reduction in lower extremity complications with MANTA decannulation compared with open decannulation from femoral VA ECMO, thus allowing for safe bedside decannulation. Percutaneous SFA closure has outcomes equivalent to those of manual pressure.