Acute vascular complications of femoral venoarterial ECMO; a single center retrospective study

Abstract

\n \n \n Type of funding sources: None.\n \n \n \n Emergent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to provide rapid cardiopulmonary resuscitation in adult patients with refractory cardiogenic shock . Femoral arterial cannulation may result in\xa0 ipsilateral limb ischemia due to\xa0 reduced distal\xa0 blood flow below the insertion point of the cannula .We retrospectively studied\xa0 adult patients supported with femoral VA-ECMO for cardiogenic shock between\xa0 2015 and 2019 at our tertiary care hospital.\xa0\n Results : the study included 65 adult patients supported on femoral VA-ECMO\xa0 for refractory cardiogenic shock . The studied patients had\xa0 a mean age of 37.9\u2009±\u200914.87 years , mostly males (70.8%) , a mean\xa0 BSA of 1.77 ±0.27 m2 and a mean BMI of 26.1 ± 6.7 kg/m2 . Twenty one (32.3%) patients developed acute lower limb ischemia. Femoral thrombectomy and angioplasty were done in 20 (30.8% ) patients . Four\xa0 (6.2%) patients developed limb compartmental syndrome and fasciotomy was done . Amputation of toes was done in one patient . The vascular complications included cannulation site bleeding in 24.6% of patients ,\xa0 femoral arteriovenous fistula in one patient and\xa0 large pseudoaneurysm after ECMO decannulation and required vascular surgical repair . Three (4.6%) patients developed chronic limb ischemia manifestations after hospital discharge . The patients who developed acute\xa0 limb ischemia had significantly frequent AKI (<0.001) without significant use of haemodialysis (p\u2009=\u20090.07) and longer ICU stay (p\u2009=\u20090.028) compared to the patients without limb ischemia. The hospital mortality occurred in 29 (44.6%)\xa0 patients\xa0 without significant difference between the patients with and without acute limb ischemia.\xa0 The\xa0 occurrence of acute\xa0 limb ischemia was significantly\xa0 correlated with failed percutaneous femoral cannulation (p\u2009=\u20090.039 )\xa0 while there was no significant statistical correlation between the\xa0 cut-down technique and occurrence of limb ischemia(p\u2009=\u20090.053).\xa0 The occurrence of femoral cannulation site bleeding was significantly correlated with failed percutaneous cannulation (p\u2009=\u20090.001 ) and cut-down technique (p\u2009=\u20090.001) .\xa0\n Conclusion :\xa0 Acute vascular complications are frequent after femoral VA-ECMO. Failed percutaneous femoral cannulation has been, in this study identified as the most important risk factor for acute limb ischemia and cannulation site bleeding. Recommendation: A careful approach during femoral cannulation is recommended to prevent occurrence of acute limb ischemia and femoral cannulation site bleeding. Abstract Figure. Cannulation approaches of VA-ECMO .\n