Background
Extracorporeal membrane oxygenation (ECMO) is a life-saving modality increasingly
used in the management cardiopulmonary failure. However, ECMO itself is not without
major complications. Mortality remains high, and morbidity such as stroke, renal failure,
and acute limb threatening ischemia (ALI) are common among surviving patients. We
analyzed the effect of one of these complications, ALI, on the survival of patients
receiving venoarterial ECMO (VA ECMO) with femoral cannulation.
Methods
Patients with cardiopulmonary failure supported by VA ECMO inserted through femoral
cannulation at two institutions from December 2010 to December 2017 were enrolled
in this study. Data were collected retrospectively. Our primary outcome was ALI and
its effect on hospital mortality. Secondary outcomes included six-month mortality,
length of hospital stay, and other complications (stroke and renal failure); multivariate
logistic regression analysis was used to identify predictors of ALI and hospital mortality.
Results
There were 71 patients included in this study. The overall VA ECMO hospital mortality
was 53.5%. ALI was seen in 14 (19.7%) patients. Of these, four (5.6%) patients had
fasciotomy, four patients (5.6%) had thrombectomy, and one underwent arterial repair
(1.4%). Five additional patients (7.0%) with ALI expired and had no vascular intervention.
None of the demographic and clinical characteristics significantly correlated with
ALI except for stroke and renal failure requiring new-onset hemodialysis (HD). The
rate of hospital and 6-month mortality in patients with and without vascular complications
were 78.6%, 92.3% and 47.4%, 57.4%, respectively (P = 0.042 and P = 0.023). Multivariate analysis correlated hospital and six-month mortality with
ALI, stroke, and new-onset HD.
Conclusions
ALI correlates with higher mortality in VA ECMO patients with femoral cannulation.
Although some of the contributing factors to mortality in these patients are related
to the consequences of cardiopulmonary failure, strong efforts should be made to avoid
ALI after femoral VA ECMO cannulation.
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References
- Extracorporeal oxygenation in cardiopulmonary disease in adults.J Am Coll Cardiol. 2014; 63: 2769-2778
- Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial.Lancet. 2009; 374: 1351-1363
- The evolving use of ECMO: the impact of the CESAR trial.Int J Surg. 2016; 35: 95-99
- 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
- Prognostic factors for adult patients receiving extracorporeal membrane oxygenation as mechanical circulatory support–a 14-year experience at a medical center.Artif Organs. 2010; 34: E59-E64
- Clinical experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure: survival at five years.J Thorac Cardiovasc Surg. 2001; 122: 92-102
- Early vascular complications after percutaneous cannulation for extracorporeal membrane oxygenation for cardiac assist.Minerva Anestesiol. 2016; 82: 36-43
- Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support.Ann Thorac Surg. 2011; 92: 626-631
- The impact of vascular complications on survival of patients on venoarterial extracorporeal membrane oxygenation.Ann Thorac Surg. 2016; 101: 1729-1734
- Limb ischemia during femoral cannulation for cardiopulmonary support.J Vasc Surg. 2010; 52: 850-853
- Lower-extremity complications with femoral extracorporeal life support.J Thorac Cardiovasc Surg. 2016; 151: 1738-1744
- Arterial complications in patients undergoing extracorporeal membrane oxygenation via femoral cannulation.Ann Vasc Surg. 2014; 28: 178-183
- A meta-analysis of complications and mortality of extracorporeal membrane oxygenation.Crit Care Resusc. 2013; 15: 172-178
- Cannulation-related complications on veno-arterial extracorporeal membrane oxygenation: prevalence and effect on mortality.Artif Organs. 2017; 41: 827-834
- 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
- Factors associated with ipsilateral limb ischemia in patients undergoing femoral cannulation extracorporeal membrane oxygenation.Ann Vasc Surg. 2019; 54: 60-65
- Late vascular complications after extracorporeal membrane oxygenation support.Ann Thorac Surg. 2006; 81: 892-895
- Arterial protocol including prophylactic distal perfusion catheter decreases limb ischemia complications in patients undergoing extracorporeal membrane oxygenation.J Vasc Surg. 2017; 65: 1074-1079
- Using near-infrared spectroscopy to monitor lower extremities in patients on venoarterial extracorporeal membrane oxygenation.Ann Thorac Surg. 2014; 98: 1853-1854
- Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock.J Thorac Cardiovasc Surg. 2010; 139 (311.e1): 302-311
- A simple technique of distal limb perfusion during prolonged femoro-femoral cannulation.J Cardiovasc Surg. 2006; 21: 168-169
- Does a distal perfusion cannula reduce ischaemic complications of extracorporeal membrane oxygenation?.ANZ J Surg. 2016; 86: 1002-1006
- Axillary artery cannulation for extracorporeal membrane oxygenator support in adults: an approach to minimize complications.J Thorac Cardiovasc Surg. 2003; 126: 2097-2098
- Modified T-graft for extracorporeal membrane oxygenation in a patient with small-caliber femoral arteries.Tex Heart Inst J. 2015; 42: 537-539
- Arterial chimney graft cannulation for interventional lung assist.Ann Thorac Surg. 2012; 94: 1335-1337
Article Info
Publication History
Published online: August 23, 2019
Accepted:
June 7,
2019
Received:
March 26,
2019
Footnotes
Conflict of interest: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
