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DOI: 10.1055/s-0037-1598691
A Distal Limb Perfusion Cannula Is Mandatory in Extracorporeal Membrane Oxygenation with Femoral Access
Publication History
Publication Date:
03 February 2017 (online)
Background: Extracorporeal membrane oxygenation (ECMO) is a temporary mechanical circulatory support device for patients with acute heart and lung failure. Cannulation of the femoral vessels is the most common access site allowing quick and easy ECMO insertion. However, several complications are described. Distal limb ischemia is one of the most frightened complications of ECMO therapy. Aim of this study is to evaluate the use of a distal limb perfusion cannula for the prevention of malperfusion.
Methods: We retrospectively reviewed 168 patients (mean age: 53.4 ± 16.9 years) that were in need of veno-arterial (V-A) extracorporeal life support in the time between January 2014 and December 2015 in our institution. In 87 (51.8%) patients distal limb perfusion was achieved with a 6–8 Fr. cannula attached to the side-port of the arterial cannula and compared with patients without a distal limb perfusion cannula.
Results: In all 168 patients, venous 20 Fr. or 25 Fr. multistage cannulas and arterial 15 Fr.-21 Fr. cannulas were used. In total, 16 (9.5%) patients developed signs of ischemia and six of them (3.7%) experienced a compartment syndrome requiring surgical intervention with implantation of a distal perfusion cannula. Surgery for compartment syndrome included fasciotomy of all compartments, three patients (1,8%) required a below-knee amputation.
The incidences of limb ischemia (16.4 vs. 1.9%; p = 0.01) and limb ischemia requiring surgical intervention (7.3 vs. 0%; p = 0.04) were significantly higher for the patients without a distal leg perfusion cannula. The diameter of the cannula for distal leg perfusion showed no significant effect on the outcome, as well as the diameter of the arterial cannula.
None of the patients developing a compartment-syndrome with the need of surgical intervention survived the hospital stay.
Conclusion: In patients with V-A-ECMO a distal perfusion cannula significantly reduced distal limb ischemia and was associated with better survival. Therefore, it should be established in every V-A-ECMO patient cannulated in the groin.