Cannulation-related adverse events of peripheral veno-arterial extracorporeal membrane oxygenation support in heart transplantation: Axillary versus femoral artery cannulation

Background: In heart transplantation (HT), peripheral veno-arterial extracorporeal membranous oxygenation (VA-ECMO) is utilized preoperatively as a direct bridge to HT or postoperatively for primary graft dysfunction (PGD). Little is known about wound complications of an arterial VA-ECMO cannulation site which can be fatal. Methods: From 2009 to 2021, outcomes of 80 HT recipients who were supported with peripheral VA-ECMO either preoperatively or postoperatively were compared based on the site of arterial cannulation: axillary (AX: N = 49) versus femoral artery (FA: N = 31). Results: Patients in the AX group were older (AX: 59 years vs. 52 years, p =.006), and less likely to have extracorporeal cardiopulmonary resuscitation (0% vs. 12.9%, p =.040). Survival to discharge (AX, 81.6% vs. FA. 90.3%, p =.460), incidence of stroke (10.2% vs. 6.5%, p =.863), VA-ECMO cannulation-related bleeding (6.1% vs. 12.9%, p =.522), and arm or limb ischemia (0% vs. 3.2%, p =.816) were comparable. ECMO cannulation-related wound complications were lower in the AX group (AX, 4.1% vs. FA, 45.2%, p <.001) including the wound infections (2.0% vs. 32.3%, p <.001). In FA group, all organisms were gram-negative species. In univariate logistic regression analysis, AX cannulation was associated with less ECMO cannulation-related wound complications (Odds ratio,.23, p <.001). There was no difference between cutdown and percutaneous FA insertion regarding cannulation-related complications. Conclusions: Given the lower rate of wound complications and comparable hospital outcomes with femoral cannulation, axillary VA-ECMO may be an excellent option in HT candidates or recipients when possible.