Feasibility of the area reduction post-closure technique for bedside weaning of veno-arterial extracorporeal membrane oxygenation

Objective To evaluate the safety and efficacy of the area reduction post-closure technique for bedside weaning of veno-arterial extracorporeal membrane oxygenation (V-A ECMO).Methods A retrospective study was conducted from December 2022 to November 2023, analyzing data from patients who underwent V-A ECMO weaning at our center. The area reduction post-closure technique, utilizing two ProGlide devices (Abbott Vascular, Santa Clara, CA), was adopted as a standard practice. The technical success was defined as achieving complete hemostasis without a bailout open repair. The complications associated with access included hemorrhagic events, pseudoaneurysm formation, limb ischemia, distal embolization, and wound infections.Results A total of 18 patients were included. The median age of the cohort was 72.0 years [interquartile range (IQR), 57.5-81.5 years], with a male-to-female ratio of 2:1. The median size of arterial sheath utilized was 18.0 Fr (IQR, 17.0-20.0 Fr). The median duration of the procedure was 10.0 min (IQR, 9.0-13.0 min), and the median length of total hospital stay was 31.0 days (IQR, 25.5-39.0 days). Furthermore, the technique demonstrated a success rate of 100%. One patient (5.6%) experienced minor bleeding, which was successfully managed through compression. No additional complications associated with access were observed after the procedure.Conclusions The post-closure area reduction technique emerges as a viable option for bedside weaning of V-A ECMO. Nonetheless, it is essential that this technique be validated through larger comparative studies.