Percutaneous Versus Surgical Cannulation for Femoro-Femoral Venoarterial Extracorporeal Membrane Oxygenation: A Retrospective Cohort Study on Cannulation-Related Complications

Axel Dimberg; Magnus Dalén; Anders Franco-Cereceda; Thomas Fux

doi:10.1111/aor.70061

Percutaneous Versus Surgical Cannulation for Femoro-Femoral Venoarterial Extracorporeal Membrane Oxygenation: A Retrospective Cohort Study on Cannulation-Related Complications

Artif Organs. 2025 Nov 21. doi: 10.1111/aor.70061. Online ahead of print.

Authors

Axel Dimberg^{1

2}, Magnus Dalén^{1

2}, Anders Franco-Cereceda^{1

2}, Thomas Fux^{3

4}

Affiliations

¹ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
² Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.
³ Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
⁴ Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.

PMID: 41271561
DOI: 10.1111/aor.70061

Abstract

Background: Cannulation for peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) can lead to severe local complications. This study evaluated site-specific complications between percutaneous and surgical cannulation techniques for femoro-femoral V-A ECMO, focusing on site bleeding, infection, and limb ischemia.

Methods: We conducted a single-center retrospective cohort study of adult patients who received femoro-femoral V-A ECMO either by percutaneous or surgical technique at a tertiary center. Cannulation-site complications were assessed from cannulation to post-decannulation. Risk factors for site bleeding, infection, and limb ischemia within 90 days of cannulation were analyzed using logistic regression.

Results: Among 384 patients (22.4% female), 181 (47.1%) underwent percutaneous, and 203 (52.9%) underwent surgical cannulation. Percutaneous cannulation was associated with significantly fewer patients experiencing site bleeding (29.3% vs. 40.9%, p = 0.02) and infection (8.3% vs. 31.0%, p < 0.001), with no significant difference in limb ischemia (11.6% vs. 15.3%, p = 0.29). 90-day survival was similar between groups (43.6% vs. 49.8%, p = 0.81). Multivariable logistic regression identified surgical cannulation as an independent risk factor for site bleeding (OR 2.39, 95% CI 1.43-3.98; p < 0.001) and infection (OR 5.47; 95% CI 2.47-12.12; p < 0.001). Limb ischemia was not significantly associated with the cannulation technique but with two other modifiable factors at cannulation: absence of distal perfusion catheterization and larger arterial cannula size.

Conclusion: Percutaneous cannulation was associated with significantly fewer patients experiencing site bleeding and infection compared to surgical cannulation. Limb ischemia was not associated with the cannulation technique but was influenced by two other modifiable factors at cannulation: distal perfusion catheterization and arterial cannula size.

Keywords: V‐A ECMO; cannulation‐related complications; femoral cannulation; percutaneous cannulation; surgical cannulation; venoarterial ECMO.