Differences in Treatment Outcomes According to the Insertion Method Used in Extracorporeal Cardiopulmonary Resuscitation: A Single-Center Experience

Background: Venoarterial extracorporeal membrane oxygenation (ECMO) is a key treat ment method used with patients in cardiac arrest who do not respond to medical treat ment.A critical step in initiating therapy is the insertion of ECMO cannulas.Peripheral ECMO cannulation methods have been preferred for extracorporeal cardiopulmonary resuscitation (ECPR).Methods: Patients who underwent ECPR at Daegu Catholic University Medical Center between January 2017 and May 2023 were included in this study.We analyzed the impact of 2 different peripheral cannulation strategies (surgical cutdown vs. percutaneous cannu lation) on various factors, including survival rate.Results: Among the 99 patients included in this study, 66 underwent surgical cutdown, and 33 underwent percutaneous insertion.The survival to discharge rates were 36.4% for the surgical cutdown group and 30.3% for the percutaneous group (p=0.708).The ECMO insertion times were 21.3 minutes for the surgical cutdown group and 10.3 minutes for the percutaneous group (p<0.001).The factors associated with overall mortality included a shorter lowflow time (hazard ratio HR, 1.045; 95% confidence interval CI, 1.019-1.071;p=0.001) and whether return of spontaneous circulation was achieved (HR, 0.317; 95% CI, 0.127-0.787;p=0.013).Lowflow time was defined as the time from the start of cardiopul monary resuscitation to the completion of ECMO cannula insertion. Conclusion:No statistically significant difference in inhospital mortality was observed between the surgical and percutaneous groups.However, regardless of the chosen cannu lation strategy, reducing ECMO cannulation time was beneficial, as a shorter lowflow time was associated with significant benefits in terms of survival.