Introduction: Although post-cardiotomy extracorporeal membrane oxygenation (ECMO) is associated with high mortality¹, the impact of cannulation site is poorly understood.

Methods: We conducted a retrospective review of our post-cardiotomy veno-arterial ECMO patients. All other cannulation types were excluded. Primary stratification was by central (direct aortic) or peripheral (femoral/axillary) cannulation. Survival, complications, and blood product transfusion rates were evaluated.

Results: From 2012-2024, 59 patients required post-cardiotomy ECMO cannulation. The average age was 65±12 years and 34(58%) patients were male. All underwent coronary, valvular, or aortic surgery, and 21(36%) were re-operative surgeries. 22(37%) were cannulated centrally, while 37(63%) were cannulated peripherally. Of those cannulated centrally, 7(32%) were converted to peripheral cannulation. Central and peripheral cannulations had both similar survival to decannulation (14/22, 64% vs. 23/37, 62%, p=0.96), and survival to discharge (7/22, 32% vs. 12/37, 32%, p=0.97). Also, no significant differences in rates of stroke (4/22, 18% vs. 5/37, 14%, p=0.68), infection (2/22, 9% vs. 6/37, 16%, p=0.46), or renal failure (7/22, 32% vs. 10/37, 27%, p=0.77). However, central cannulation required significantly more units of packed red blood cells (28±19 vs. 21±16, p=0.04) and more cryoprecipitate (7±5 vs. 5±4, p=0.04) but similar quantities of fresh frozen plasma (7±4 vs. 6±5, p=0.53) and platelets(15±10 vs.11±7, p=0.15).

Conclusions: For post-cardiotomy ECMO, central and peripheral cannulations had similar mortality and complications. However, central cannulation was associated with an increased need for blood and cryoprecipitate. Further investigation is warranted.