IntroductionFollowing weaning of peripheral venoarterial extracorporeal membrane oxygenation (ECMO) support, removal of cannulas and repair of large-bore arterial sites is traditionally by open surgical repair (OSR). The use of a percutaneous vascular closure device (VCD) offers a minimally invasive alternative to OSR with potential for reduced operative complications, reduced hospital length of stay and in-hospital mortality.MethodsA systematic review of Medline and Embase databases was conducted for studies comparing VCD-assisted decannulation with OSR following decannulation of peripheral ECMO. The primary endpoint was rate of post-procedural complications, namely wound infection and limb ischaemia. The secondary endpoint was in-hospital mortality.ResultsEight studies, with a total of 685 patients, met inclusion criteria. Forty-eight percent ( n = 328) of patients underwent VCD-assisted decannulation with the remainder decannulated by OSR. Pooled analysis demonstrated that patients undergoing VCD-assisted decannulation are at significantly lower risk of overall complications than surgical repair (OR 4.34; 95% CI 2.19-8.57; p < .001). Specifically, there was a substantial decrease in groin infections (OR 6.77; 95% CI 3.07-14.97; p < .001) without notable differences in limb ischaemia or pseudoaneurysm occurrence between the VCD and OSR cohorts. There was a lower incidence of intra-operative bleeding and haematoma in the VCD cohort ( p < .001 and p = .002, respectively).ConclusionVascular closure device-assisted decannulation of peripheral ECMO offers a significantly reduced risk of complications, particularly groin infections and bleeding. Future research should encompass larger cohorts, randomised controlled trials, cost-benefit analyses, and the training of surgeons, cardiologists and intensivists in VCD-assisted decannulation, potentially through the integration of simulation-based training.

中文翻译：

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经皮拔管与开放手术修复大口径体外膜肺动脉入路部位的比较

简介在撤除外周静脉动脉体外膜氧合 (ECMO) 支持后，传统上通过开放手术修复 (OSR) 来移除插管并修复大口径动脉部位。经皮血管闭合装置 (VCD) 的使用提供了 OSR 的微创替代方案，有可能减少手术并发症、缩短住院时间和院内死亡率。方法对 Medline 和 Embase 数据库进行了系统回顾，以比较 VCD 的研究- 外周 ECMO 拔管后使用 OSR 辅助拔管。主要终点是术后并发症的发生率，即伤口感染和肢体缺血。次要终点是院内死亡率。结果 8 项研究（总共 685 名患者）符合纳入标准。 48% (n = 328) 的患者接受了 VCD 辅助拔管，其余患者则通过 OSR 拔管。汇总分析表明，接受 VCD 辅助拔管的患者总体并发症的风险显着低于手术修复（OR 4.34；95% CI 2.19-8.57；p < .001）。具体而言，VCD 组和 OSR 组之间的腹股沟感染显着减少（OR 6.77；95% CI 3.07-14.97；p < .001），但肢体缺血或假性动脉瘤发生率没有显着差异。 VCD 队列中术中出血和血肿的发生率较低（分别为 p < .001 和 p = .002）。 结论 血管闭合装置辅助外周 ECMO 拔管可显着降低并发症风险，特别是腹股沟感染和流血。未来的研究应包括更大的队列、随机对照试验、成本效益分析，以及外科医生、心脏病专家和重症医生在 VCD 辅助拔管方面的培训（可能通过整合基于模拟的培训）。