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Background <p>Percutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implantation reduces infectious complications compared with surgical cannulation. However, arterial decannulation using manual compression remains associated with bleeding, vascular injury, and infection. We evaluated a fully percutaneous decannulation strategy (FP-D) combining MANTA<sup>®</sup> and Femoseal<sup>®</sup> devices.</p> Methods <p>All patients undergoing FP-D between October 2020 and May 2022 in our institution were included. Outcomes were compared with a historical cohort decannulated using manual compression (MC). The primary endpoint was surgical revision after decannulation. Secondary endpoints included major bleeding, transfusion, vascular complications, infection, and 30-day survival. A propensity score weighting approach was performed to adjust for baseline differences.</p> Results <p>Among 497 patients treated with percutaneous VA-ECMO, 250 underwent FP-D and 247 MC. After propensity score, FP-D significantly reduced surgical revision (3.9% vs. 7.2%; RR 0.55, 95% CI 0.32–0.94; <i>p</i> = 0.0311), infection requiring surgery (3.7% vs. 8.4%; RR 0.44, 95% CI 0.25–0.77; <i>p</i> = 0.004), and major bleeding (1.4% vs. 11%; RR 0.13, 95% CI 0.06–0.30; <i>p</i> &lt; 0.0001), with lower transfusion requirements (7.1% vs. 45.7%; RR 0.16, 95% CI 0.11–0.22; <i>p</i> &lt; 0.0001). Thirty-day death was comparable between groups (8,2% vs. 5,57%; <i>p</i> = 0.1316). Systematic CT scans revealed frequent but mostly silent arterial lesions after FP-D.</p> Conclusion <p>FP-D markedly reduced bleeding, transfusion, infection, and surgical revision compared with manual compression, while preserving short-term survival. Systematic imaging identified frequent subclinical vascular lesions, supporting targeted surveillance and endovascular management when appropriate.</p>

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Full percutaneous decannulation of VA-ECMO using MANTA® and Femoseal® devices: a propensity-score based study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月12日

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  • Elodie Berg,
  • Charles Juvin,
  • Marc Pineton De Chambrun,
  • Charifa Nazoiri,
  • Nathalie Nardone,
  • Pichoy Danial,
  • Cosimo D’Alessandro,
  • Aude Carillion,
  • Alain Combes,
  • Pascal Leprince,
  • Adrien Bougle,
  • Guillaume Lebreton

摘要

Background

Percutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implantation reduces infectious complications compared with surgical cannulation. However, arterial decannulation using manual compression remains associated with bleeding, vascular injury, and infection. We evaluated a fully percutaneous decannulation strategy (FP-D) combining MANTA® and Femoseal® devices.

Methods

All patients undergoing FP-D between October 2020 and May 2022 in our institution were included. Outcomes were compared with a historical cohort decannulated using manual compression (MC). The primary endpoint was surgical revision after decannulation. Secondary endpoints included major bleeding, transfusion, vascular complications, infection, and 30-day survival. A propensity score weighting approach was performed to adjust for baseline differences.

Results

Among 497 patients treated with percutaneous VA-ECMO, 250 underwent FP-D and 247 MC. After propensity score, FP-D significantly reduced surgical revision (3.9% vs. 7.2%; RR 0.55, 95% CI 0.32–0.94; p = 0.0311), infection requiring surgery (3.7% vs. 8.4%; RR 0.44, 95% CI 0.25–0.77; p = 0.004), and major bleeding (1.4% vs. 11%; RR 0.13, 95% CI 0.06–0.30; p < 0.0001), with lower transfusion requirements (7.1% vs. 45.7%; RR 0.16, 95% CI 0.11–0.22; p < 0.0001). Thirty-day death was comparable between groups (8,2% vs. 5,57%; p = 0.1316). Systematic CT scans revealed frequent but mostly silent arterial lesions after FP-D.

Conclusion

FP-D markedly reduced bleeding, transfusion, infection, and surgical revision compared with manual compression, while preserving short-term survival. Systematic imaging identified frequent subclinical vascular lesions, supporting targeted surveillance and endovascular management when appropriate.