Abstract
Decannulation of patients on peripheral veno-arterial extracorporeal membrane oxygenation (VA ECMO) typically involves femoral arterial cutdown and surgical arteriotomy closure in an operating room under general anesthesia. However, this requires exposure of the still-fragile ECMO patient to the risks of transport from the intensive care unit (ICU), the depressive cardiovascular effects of general anesthesia, and often of re-induction and intubation of a patient who passed their ECMO wean while awake and extubated. We describe a case series in which a novel technique for percutaneous closure of peripheral, percutaneously placed veno-arterial ECMO sites has allowed for safe and reliable closure is achieved in awake, extubated patients, at bedside in the ICU. Common femoral arterial (CFA) sites are closed by accessing the arterial cannula with an 18ga needle, introducing a wire into the CFA over which the arterial cannula is removed and the site subsequently closed with a Teleflex MANTA Closure Device and the superficial femoral artery reperfusion site with a Mynx Vascular Closure Device. In our ten-patient series, complications were minimal, with none developing limb ischemia requiring procedural intervention, failed hemostasis, conversion to cutdown, or requiring intubation or conversion to general anesthesia. In one case, wire access to the artery was lost prematurely but hemostasis was maintained with manual pressure and no further intervention was required. Percutaneous bedside closure of peripheral VA ECMO sites appears feasible and safe. Further study would help hone technique as well as elucidate complication rates and cost saving compared with traditional techniques.