(1163) Comparative Venovenous Extracorporeal Membrane Oxygenation Cannulation by Intensivists and Surgeons

Introduction: Cannulation for, and initiation of, venovenous extracorporeal membrane oxygenation (VV-ECMO) can be accomplished by non-surgeon intensivists or surgeons.

Methods: We retrospectively reviewed all adult VV-ECMO patients admitted from 1/2019-1/2023 to describe risk factors and outcomes. Each cannulation was categorized as performed by an intensivist or cardiothoracic surgeon with analyses done on a per-cannulation site basis. Multivariable logistic regression was used to explore the association between relevant clinical characteristics, selected a priori, and complications and survival to decannulation.

Results: During the study period, 181 patients were cannulated for VV-ECMO, with 407 cannulation events. Of the cannulation events, 41% were performed by intensivists and 59% performed by surgeons. Compared to surgeons, intensivists cannulated the internal jugular vein more often (45.5% vs 36.7%, p< 0.001) versus the subclavian vein (1.8% vs 12.9%, p< 0.001). Intensivists performed more initial cannulations (97% vs 82.1%, p< 0.001) with surgeons more frequently adding or reconfiguring cannulas (12.5% vs 1.2%, p< 0.001). Intensivists completed more remote cannulations (86.8% vs 61.7%). Patients cannulated by intensivists were younger (41.31 [12.3] vs 45.90 [13.98], p=0.001), had a higher RESP score (2.74 [4.29] vs 1.93 [3.77], p< 0.046), and lower pre-cannulation lactic acid (1.7 [0.91-2.84] vs 2.10 [1.28-3.95], p< 0.001).

Overall mortality on ECMO for the cohort was 25.3%. Between intensivists and surgeons, unadjusted survival to decannulation (24% vs 26.2%, p=0.683) and unadjusted complication rates (13.8% vs 15.8%, p=0.66) were similar. Subclavian site (OR 4.70 [1.6-14.18], p=0.05) was independently associated with complications. After adjusting for relevant confounders, there was no significant association between cannulator category and complications or survival to decannulation.

Conclusions: In this single center study of 407 cannulation events, cannulating intensivists had comparable outcomes to surgeons. Intensivists performed more remote cannulations, cannulated younger patients, and those with lower lactic acid levels and higher RESP score. A center with a multidisciplinary team, where intensivists are partnered with surgeons, can safely and efficaciously cannulate and initiate VV-ECMO.