Vascular Complications of Lower Limb Ischemia in Patients with Femoral Venoarterial Extracorporeal Membrane Oxygenation
Keywords:ECMO; femoral artery; limb ischemia
Background: Lower limb ischemia in patients with extracorporeal membrane oxygenation (ECMO) via femoral artery catheterization negatively affects patient mortality and survivors’ quality of life [Gulkarov 2020]. In this study, ECMO was established via femoral artery catheterization. This study aimed to identify the risk factors of lower limb ischemia to provide sufficient evidence for
Methods: All patients with venoarterial (VA) ECMO via femoral artery catheterization in Zhongshan People’s Hospital from January 2008 to November 2019 retrospectively were analyzed. Patients’ general information and ECMO-related information were obtained, and the main outcome variables were survival and discharge and intubation-related adverse events (limb ischemia and incision bleeding). Logistic regression analysis was used to determine the independent risk factors of limb ischemia in patients with VA ECMO.
Results: A total of 179 (98 [54.7%] men and 81 [45.3%] women) eligible patients were included in this study. Moreover, a total of 90 patients (48.9%) had low cardiac output, 41 (22.3%) had acute myocardial infarction, and 33 (17.9%) had fulminant myocarditis. Eighty-six (48.04%) patients survived to hospital discharge, 36 (20.11%) had limb ischemia, and 42 (23.46%) had incision bleeding. Furthermore, the ECMO-assisted time was 114.23 ± 67.88 hours. There was no significant difference in age, sex, and Sequential Organ Failure Assessment score between the limb ischemia group and the non-limb ischemia group. Multivariate logistic regression analysis showed that peripheral artery disease (odds ratio, 27.12; 95% confidence interval, 5.614–130.96) was an independent risk factor of limb ischemia in patients with ECMO.
Conclusion: Limb ischemia is a common complication in patients with VA ECMO, and peripheral artery disease is an independent risk factor of limb ischemia in patients with VA ECMO via femoral artery catheterization.
Augusto R, Passos S M, Campos J, et al. 2019. Arterial vascular complications in peripheral venoarterial extracorporeal membrane oxygenation support[J]. Rev Port Cir Cardiotorac Vasc 26(1):45-50.
Bisdas T, Beutel G, Warnecke G, et al. 2011. Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support[J]. Ann Thorac Surg 92(2):626-631.
Das G J, Saavedra R, Guliani S, et al. 2018. Decompressive laparotomy for a patient on VA-ECMO for massive pulmonary embolism that suffered traumatic liver laceration after mechanical CPR[J]. J Surg Case Rep (10):y292.
Dohain A M, Abdelmohsen G, Elassal A A, et al. 2019. Factors affecting the outcome of extracorporeal membrane oxygenation following paediatric cardiac surgery [J]. Cardiol Young 1-9.
Gulkarov I, Bobka T, Elmously A, et al. 2020. The effect of acute limb ischemia on mortality in patients undergoing femoral venoarterial extracorporeal membrane oxygenation [J]. Ann Vasc Surg 62:318-325.
Hu W, Mao S, Hu W, et al. 2011. ECMO support in a child with acute fulminant myocarditis[J]. Indian J Pediatr 78(5):609-612.
Jayaraman A L, Cormican D, Shah P, et al. 2017. Cannulation strategies in adult veno-arterial and veno-venous extracorporeal membrane oxygenation: Techniques, limitations, and special considerations[J]. Ann Card Anaesth 20(Supplement):S11-S18.
Karami M, den Uil C A, Ouweneel D M, et al. 2019. Mechanical circulatory support in cardiogenic shock from acute myocardial infarction: Impella CP/5.0 versus ECMO[J]. Eur Heart J Acute Cardiovasc Care 1420982051.
Kaushal M, Schwartz J, Gupta N, et al. 2019. Patient demographics and extracorporeal membranous oxygenation (ECMO)-related complications associated with survival to discharge or 30-day survival in adult patients receiving venoarterial (VA) and venovenous (VV) ECMO in a quaternary care urban center[J]. J Cardiothorac Vasc Anesth 33(4):910-917.
Kawabori M, Mastroianni M A, Zhan Y, et al. 2019. A case series: the outcomes, support duration, and graft function recovery after VA-ECMO use in primary graft dysfunction after heart transplantation[J]. J Artif Organs.
Kim J, Cho Y H, Sung K, et al. 2019. Impact of cannula size on clinical outcomes in peripheral venoarterial extracorporeal membrane oxygenation[J]. ASAIO J 65(6):573-579.
Lamb K M, DiMuzio P J, Johnson A, et al. 2017. Arterial protocol including prophylactic distal perfusion catheter decreases limb ischemia complications in patients undergoing extracorporeal membrane oxygenation[J]. J Vasc Surg 65(4):1074-1079.
Li Y T, Yang L F, Chen Z G, et al. 2017. ECMO as an effective rescue therapeutic for fulminant myocarditis complicated with refractory cardiac arrest[J]. Ther Clin Risk Manag 13:1507-1511.
Lupei M I, Kloesel B, Trillos L, et al. 2019. Survival of intraoperative massive pulmonary embolism using alteplase and VA-ECMO[J]. J Clin Anesth 57:112.
Madonna R, De Caterina R. 2011. Cellular and molecular mechanisms of vascular injury in diabetes--part I: pathways of vascular disease in diabetes[J]. Vascul Pharmacol 54(3-6):68-74.
McNally M M, Univers J. 2018. Acute limb ischemia[J]. Surg Clin North Am 98(5):1081-1096.
Poptsov V, Spirina E, Dogonasheva A, et al. 2019. Five years’ experience with a peripheral veno-arterial ECMO for mechanical bridge to heart transplantation[J]. J Thorac Dis 11(Suppl 6):S889-S901.
Ranney D N, Benrashid E, Meza J M, et al. 2018. Vascular complications and use of a distal perfusion cannula in femorally cannulated patients on extracorporeal membrane oxygenation[J]. ASAIO J 64(3):328-333.
Tanaka D, Hirose H, Cavarocchi N, et al. 2016. The impact of vascular complications on survival of patients on venoarterial extracorporeal membrane oxygenation[J]. Ann Thorac Surg 101(5):1729-1734.
Unai S, Khullar V, Elgharably H, et al. 2019. ECMO as a bridge to reoperative cardiac surgery in a patient with cardiogenic shock and severe aortic insufficiency due to an acute aortic valve homograft failure[J]. Heart Surg Forum 22(4):E281-E282.
Yau P, Xia Y, Shariff S, et al. 2019. Factors associated with ipsilateral limb ischemia in patients undergoing femoral cannulation extracorporeal membrane oxygenation[J]. Ann Vasc Surg 54:60-65.
Yen C C, Kao C H, Tsai C S, et al. 2018. Identifying the risk factor and prevention of limb ischemia in extracorporeal membrane oxygenation with femoral artery cannulation[J]. Heart Surg Forum 21(1):E18-E22.
Zimpfer D, Heinisch B, Czerny M, et al. 2006. Late vascular complications after extracorporeal membrane oxygenation support[J]. Ann Thorac Surg 81(3):892-895.
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