“Awake” Cannulation of Patients for Venovenous Extracorporeal Membrane Oxygen: An Analysis of the Extracorporeal Life Support Organization Registry

IMPORTANCE: “Awake” cannulation for venovenous extracorporeal membrane oxygenation (ECMO), where patients remain spontaneously breathing without invasive mechanical ventilation during the cannulation procedure, may reduce lung injury from positive pressure ventilation and promote patient mobility. OBJECTIVES: To examine the association between “awake” cannulation for venovenous ECMO and patient outcomes. DESIGN, SETTING, AND PARTICIPANTS: Analysis of the prospectively collected by the multicenter Extracorporeal Life Support Organization registry. Patients 18 years old or older who were cannulated for venovenous ECMO between 2016 and 2022 were included. MAIN OUTCOMES AND MEASURES: Propensity score matching techniques were used to examine the association between the primary exposure of “awake” cannulation and the primary outcome of hospital mortality. RESULTS: This study analyzed data from 28,627 patients who received venovenous ECMO, including 797 (2.8%) who underwent awake cannulation. Patients undergoing awake cannulation were older (52.2 vs. 47.8 yr), had greater prevalence of chronic lung diseases (50.6% vs. 48.9%), and ischemic heart disease (4.3% vs. 2.7%) compared with those cannulated while receiving mechanical ventilation. Hospital survival to discharge was did not differ significantly between awake and nonawake cannulation groups after propensity score matching (2.4% increased rate of survival for patients cannulated awake; 95% CI, –1.7% to 6.4%; p = 0.26). CONCLUSIONS AND RELEVANCE: In this large, multicenter study, awake cannulation for venovenous ECMO was uncommon but increasingly used over time. Survival to hospital discharge was similar to patients cannulated while on mechanical ventilation. Future research should focus on identification of patient cohorts most likely to benefit from “”awake” cannulation.