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Master Thesis

Les complications vasculaires de l’ECMO artério-veineuse périphérique : l’expérience de deux centres (Fort-de-France et Rennes)

Abstract : Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is a rescue therapy in patient with sever cardiopulmonary failure. There is a high mortality between 34 and 61%. Major vascular complications (MVC) increase the mortality in these patients. In our study, patients supported with VA ECMO in Rennes and in French West Indies from January 2005 to January 2019. We analyzed the rates of vascular complications and brought out new risk factors of vascular complication, with a new statistical method: The correlation network analysis. Data were gathered retrospectively by reviewing institutional database in Rennes and in Martinique, and completed by reading the computer medical records. There were 500 VA ECMO in Rennes and 193 VA ECMO in Martinique enrolled in the study. The major vascular complications in Rennes were: 1.4% of amputations, 2.8% of fasciotomies, 2.6% of groin infections and 7.2% of bleeding. The death rate at 3 months is 38.3% with a median survival at 19 days (15-27). Some vascular anatomies (like high femoral arterial bifurcation, arterial calcification) or cannulation access increase the incidence of vascular complications. The place of cannulation, the VA ECMO indication, the time on mechanical support and an external cardiac massage have an impact of the 30-day mortality. Femoral artery cannulation with a distal perfusion catheter is the reference for cannulation strategy in VA ECMO in adults, but it has to be used after documentation of a peripheral arterial disease and in a selected population.
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Master Thesis
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Submitted on : Tuesday, July 7, 2020 - 4:38:02 PM
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Aurore Pongerard. Les complications vasculaires de l’ECMO artério-veineuse périphérique : l’expérience de deux centres (Fort-de-France et Rennes). Chirurgie. 2019. ⟨dumas-02892666⟩



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