Distal Limb Perfusion: Achilles' Heel in Peripheral Venoarterial Extracorporeal Membrane Oxygenation

2014 ◽  
Vol 38 (11) ◽  
pp. 940-944 ◽  
Author(s):  
Prashant N. Mohite ◽  
Javid Fatullayev ◽  
Olaf Maunz ◽  
Sundip Kaul ◽  
Anton Sabashnikov ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Distal Limb ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Limb Perfusion

scholarly journals Risk factors for critical limb ischemia in patients undergoing femoral cannulation for venoarterial extracorporeal membrane oxygenation: Is distal limb perfusion a mandatory approach?

Perfusion ◽  
2019 ◽  
Vol 34 (6) ◽  
pp. 453-459 ◽  
Author(s):  
Tim Kaufeld ◽  
Eric Beckmann ◽  
Fabio Ius ◽  
Nurbol Koigeldiev ◽  
Wiebke Sommer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Extracorporeal Membrane Oxygenation ◽  
Limb Ischemia ◽  
Distal Limb ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Limb Perfusion ◽  
Group A ◽  
Group B

Background: Venoarterial extracorporeal membrane oxygenation support is a well-established tool in the care of severe refractory cardiac and respiratory failure. The application of this support may serve as a bridge to transplant, recovery or to implantation of a ventricular assist device. Venoarterial extracorporeal membrane oxygenation support can be administered through an open surgical access via the common femoral or axillary artery or a percutaneous approach using Seldinger technique. Both techniques may obstruct the blood flow to the lower limb and may cause a significant ischemia with possible limb loss. Malperfusion of the distal limb can be avoided using an ipsilateral distal limb perfusion, which may be established by adding a single-lumen catheter during venoarterial extracorporeal membrane oxygenation treatment to overcome the obstruction. The aim of this study is to distinguish the presence or absence of a distal limb perfusion regarding the incidence of distal limb ischemia. Furthermore, expected risk factors of open and percutaneous femoral venoarterial extracorporeal membrane oxygenation installation were evaluated for the development of distal limb ischemia. Methods: Between January 2012 and September 2015, 489 patients received venoarterial extracorporeal membrane oxygenation support at our institution. In total, 307 patients (204 male, 103 female) with femoral cannulation were included in the analysis. The cohort was distinguished by the presence (group A; n = 237) or absence (group B; n = 70) of a distal limb perfusion during peripheral venoarterial extracorporeal membrane oxygenation treatment. Furthermore, a risk factor analysis for the development of distal limb ischemia was performed. Results: The main indications for venoarterial extracorporeal membrane oxygenation therapy were a low cardiac output syndrome (LCOS) (53%) and failed weaning of extracorporeal circulation (23%). A total of 23 patients (7.49%) under venoarterial extracorporeal membrane oxygenation support developed severe distal limb malperfusion (3.38% in group A vs 21.42% in group B). Preemptive installation of distal limb perfusion extended the intervention-free intervals to 7.8 ± 19.3 days in group A and 6.3 ± 12.5 in group B. A missing distal limb perfusion (p = 0.001) was identified as a main risk factor for critical limb ischemia. Other comorbidities such as arterial occlusion disease (p = 0.738) were not statistically significantly associated. Surgical intervention due to vascular complications after extracorporeal membrane oxygenation explantation was needed in 14 cases (4.22% in group A and 5.71% in group B). Conclusion: We were able to identify the absence of distal limb perfusion as an independent risk factor for the development of critical distal limb ischemia during femoral venoarterial extracorporeal membrane oxygenation treatment. The application of a distal limb perfusion should be considered as a mandatory approach in the context of femoral venoarterial extracorporeal membrane oxygenation treatment regardless of the implantation technique.

Distal limb perfusion cannula in peripheral extracorporeal membrane oxygenation: always a mandatory approach?

Perfusion ◽  
2019 ◽  
Vol 34 (6) ◽  
pp. 528-529 ◽  
Author(s):  
Francesco Formica ◽  
Stefano D’Alessandro ◽  
Fabio Sangalli ◽  
Leonello Avalli
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Distal Limb ◽  
Membrane Oxygenation ◽  
Limb Perfusion

scholarly journals Ankle-brachial index to monitor limb perfusion in patients with femoral venoarterial extracorporeal membrane oxygenation

2021 ◽  
Author(s):  
Andre Son ◽  
Azad Karim ◽  
Rachel Joung ◽  
Randy Mcgregor ◽  
Tingqing Wu ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Near Infrared ◽  
Pearson Correlation ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Mean Difference ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Limb Perfusion ◽  
Va Ecmo

Background: Limb ischemia is a major complication of femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO). Use of ankle-brachial index (ABI) to monitor limb perfusion in VA-ECMO has not been described. We report our experience monitoring femoral VA-ECMO patients with serial ABI and the relationships between ABI and near infrared spectroscopy (NIRS). Methods: This is a retrospective single-center review of consecutive adult patients placed on femoral VA-ECMO between January 2019 and October 2019. Data were collected on patients with paired ABI and NIRS values. Relationships between NIRS and ABI of the cannulated (E-NIRS and E-ABI) and non-cannulated legs (N-NIRS and N-ABI) along with the difference between legs (D-NIRS and D-ABI) were determined using Pearson correlation. Results: Overall, 22 patients (mean age 56.5±14.0 years, 72.7% male) were assessed with 295 E-ABI and E-NIRS measurements, and 273 N-ABI and N-NIRS measurements. Mean duration of ECMO support was 129.8±78.3 hours. ECMO-mortality was 13.6% and in-hospital mortality was 45.5%. N-ABI and N-NIRS were significantly higher than their ECMO counterparts (ABI mean difference 0.16, 95%CI 0.13-0.19, p<0.0001; NIRS mean difference 2.51, 95%CI 1.48-3.54, p<0.0001). There was no correlation between E-ABI vs. E-NIRS (r=0.032, p=0.59), N-ABI vs. N-NIRS (r=0.097, p=0.11), or D-NIRS vs. D-ABI (r=0.11, p=0.069). Conclusions: ABI is a quantitative metric that may be used to monitor limb perfusion and supplement clinical exams to identify limb ischemia in femorally cannulated VA-ECMO patients. More studies are needed to characterize the significance of ABI in femoral VA-ECMO and its value in identifying limb ischemia in this patient population.

Aggressive placement of distal limb perfusion catheter in venoarterial extracorporeal membrane oxygenation

2020 ◽  
Vol 43 (12) ◽  
pp. 796-802 ◽  
Author(s):  
Suguru Ohira ◽  
Masashi Kawamura ◽  
Kristin Ahern ◽  
Nicholas Cavarocchi ◽  
Hitoshi Hirose
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Lower Limb ◽  
Early Period ◽  
Limb Ischemia ◽  
Late Period ◽  
Distal Limb ◽  
Lower Limb Ischemia ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Distal Perfusion

Objective: The aim of this study is to review the impacts of aggressive placement of a distal perfusion catheter on the outcomes in patients supported with venoarterial extracorporeal membrane oxygenation via femoral cannulation. Methods: Analysis was performed with 143 consecutive femoral venoarterial extracorporeal membrane oxygenation cannulation. Patients were divided into two groups: the early period (October 2010 to December 2012, N = 47) where placement of a distal perfusion catheter was attempted percutaneously but not surgically and the late period (January 2013 to November 2018, N = 96) in which placement of distal perfusion catheter was aggressively utilized both percutaneously and surgically. The modification of venoarterial extracorporeal membrane oxygenation cannulation protocol for the late period involved (1) an immediate insertion of a distal perfusion catheter regardless of the size of femoral arterial cannula, (2) an open insertion of a distal perfusion catheter if percutaneous approach failed, and (3) when venoarterial extracorporeal membrane oxygenation cannulation was completed at a non-extracorporeal membrane oxygenation cannulation center, it was encouraged that they attempt insertion of a distal perfusion catheter at the time of cannulation. Results: In the late period, a distal perfusion catheter was placed in 96% (92/96) which was significantly increased from 66% (31/47) in the early period. Of these 92 patients in late period, nine patients (9.8%) required open direct insertion of a distal perfusion catheter. The incidence of lower limb ischemia (early vs. late period 26% vs 12%, P = 0.031) was significantly decreased in the late period. Logistic regression analyses showed that distal perfusion catheter placement was the only factor for preventing lower limb ischemia. Conclusion: Aggressive insertion of a distal perfusion catheter even utilizing surgical cut-down technique was shown to decrease the incidence of distal limb complications.

scholarly journals A Distal Limb Perfusion Cannula Is Mandatory in Extracorporeal Membrane Oxygenation with Femoral Access

2017 ◽  
Vol 65 (S 01) ◽  
pp. S1-S110
Author(s):  
S. Zipfel ◽  
S. Pecha ◽  
S. Braune ◽  
S. Hakmi ◽  
S. Kluge ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Distal Limb ◽  
Femoral Access ◽  
Membrane Oxygenation ◽  
Limb Perfusion

scholarly journals Distal Limb Perfusion - A Necessary Third Cannula in Extracorporeal Membrane Oxygenation

2016 ◽  
Vol 35 (4) ◽  
pp. S258
Author(s):  
S. Zipfel ◽  
S. Pecha ◽  
S. Hakmi ◽  
S. Braune ◽  
S. Kluge ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Distal Limb ◽  
Membrane Oxygenation ◽  
Limb Perfusion
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