PB0028 - The impact of cannulation site on bleeding and thrombotic outcomes in venovenous ECMO

Background: While venovenous extracorporeal membrane oxygenation (VV-ECMO) can provide lifesaving support to patients during respiratory failure, adverse hematologic events remain common. Indeed, bleeding and thrombosis complications have estimated incidences of 38% and 30%, respectively. Since both events are associated with high morbidity and mortality, a deeper understanding of risk factors in this population may lead to better informed decision-making in hemostasis management.

Aims: The objective of this study was to determine if cannulation site is a predictor for thrombotic and hemorrhagic complications in adult patients on VV-ECMO.

Methods: We performed a retrospective analysis of 11,400 adult patients from the Extracorporeal Life Support Organization (ELSO) Registry who received VV-ECMO between 2015 and 2019. Descriptive statistics were used to define relevant patient demographics including age, comorbidities, and time on ECMO. Multivariate logistic regression was then used to identify predictors of thrombotic and hemorrhagic complications.

Results: Of the 16,453 patients on VV-ECMO during the study period, 5053 were excluded, leaving 11,400 patients in the primary analysis population. In this cohort, 15.1% and 14.0% of patients had thrombotic and bleeding events, respectively. Notably, 7.3% of patients incurred both thrombotic and bleeding events. When controlling for additional clinical variables in our multivariate logistic regression, we found that cannula placement in either the internal jugular vein (OR 1.352, P < 0.001) or the pulmonary artery (OR 2.242, P < 0.001) predicted bleeding; conversely, cannulas placed in the subclavian vein decreased the odds of clotting (OR 0.556, P = 0.020). However, internal jugular vein cannulation (OR 0.888, P < 0.001), subclavian cannulation (OR 0.702, P=0.042), or pulmonary artery cannulation (OR 0.515, P=0.001) reduced the chances of surviving ECMO.

Conclusion(s): These preliminary data demonstrate that cannulation strategy choices may impact the incidence of hematologic complications and other outcomes in ECMO use. Further analysis is needed to elucidate these findings.