27 Lower limb ischaemia in patients undergoing VA ECMO

Abstract

The incidence of lower limb ischaemia ranges from 11%–52% in patients receiving VA ECMO. The reported rate of amputation ranges from 2%–10%. Patients with vascular complications related to lower limb ischaemia carries a higher risk of death. Antegrade perfusion of superficial femoral artery via a distal perfusion catheter (DPC) has been shown to be an effective therapy to reduce the incidence of lower limb ischaemia. However, the clinical indications remain largely unclear with various reported strategies. While the benefits remain largely unknown, there is increasing experience on the use of near-infrared reflectance spectroscopy, or NIRS, in the monitoring of lower limb perfusion during ECMO therapies. Strategies alternative to DPC include end-to-side graft, posterior tibial artery retrograde perfusion, axillary cannulation and central sports mode. Novel bidirectional perfusion cannula may appear as a future promising option. References Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, Esmailian F, Azarbal B. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg 2014;97:610–616. Tanaka D, Hirose H, Cavarocchi N, Entwistle JW. The impact of vascular complications on survival of patients on venoarterial extracorporeal membrane oxygenation. Ann Thorac Surg 2016;101:1729–1734. Juo YY, Skancke M, Sanaiha Y, Mantha A, Jimenez JC, Benharash P. Efficacy of distal perfusion cannulae in preventing limb ischemia during extracorporeal membrane oxygenation: a systematic review and meta-analysis. Artif Organs 2017;41:E263–E273. Wong JK, Smith TN, Pitcher HT, Hirose H, Cavarocchi NC. Cerebral and lower limb near-infrared spectroscopy in adults on extracorporeal membrane oxygenation. Artif Organs 2012;36:659–667. Spurlock DJ, Toomasian JM, Romano MA, Cooley E, Bartlett RH, Haft JW. A simple technique to prevent limb ischemia during veno-arterial ECMO using the femoral artery: the posterior tibial approach. Perfusion 2012;27:141–145. Marasco SF, Tutungi E, Vallance SA, Udy AA, Negri JC, Zimmet AD, McGiffin DC, Pellegrino VA, Moshinsky RA. A Phase 1 study of a novel bidirectional perfusion cannula in patients undergoing femoral cannulation for cardiac surgery. Innovations (Phila) 2018;13:97–103.