ID:81 FC-D04-9 Evolution of ECMO Femoral Artery Cannulation Strategies and Trends in Lower Limb Complications: A Single-Center 9-Year Cohort Study

Objective: With the maturation of percutaneous techniques, ECMO cannulation strategies have evolved significantly. This study investigates the shift from surgical cutdown to percutaneous puncture and its impact on lower limb complications. Methods: This single-center retrospective study included 1,040 patients undergoing femoral ECMO cannulation at Beijing Anzhen Hospital from January 2017 to December 2025. Patients were categorized into Percutaneous Puncture (n=595) and Surgical Cutdown (n=445) groups. We analyzed annual trends in cannulation methods, complication rates, independent risk factors via multivariate logistic regression, and in-hospital mortality using Kaplan-Meier survival analysis. Results: From 2017 to 2025, the annual ECMO volume quadrupled from 60 to 240 cases, while the lower limb complication rate decreased from 31.70 to 13.80%. The cannulation strategy shifted significantly (P<0.001) across three distinct periods: a surgical-dominant phase from 2017–2019 (81.7% cutdown); a transition phase from 2020–2022 (53.0% cutdown vs. 47.0% puncture); and a percutaneous-dominant phase from 2023–2025 (78.6% puncture). Multivariate analysis identified age≥75 years (OR=1.933), history of cerebrovascular disease (OR=1.909), surgical cutdown strategy (OR=1.609), and combined IABP use (OR=1.563) as independent risk factors for lower limb complications. Survival analysis showed that patients with lower limb complications had significantly reduced median survival compared to those without (6.46 vs. 16.02 days, P<0.001). Conclusion: Over the nine-year period, the primary femoral cannulation strategy shifted decisively from surgical cutdown to percutaneous puncture. This transition coincided with a significant decline in lower limb complications. Percutaneous puncture is a relatively safe strategy associated with better clinical prognosis and reduced in-hospital mortality.