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Online ISSN 1827-1847
Sagban T. A. 1, Duran M. 1, Schelzig H. 1, Lichtenberg A. 2, Albert A. 2, Antakyali F. 1, Dalyanoglu H. 2
1 Department of Vascular and Endovascular Surgery, Heinrich-Heine University Medical Center, Düsseldorf, Germany;
2 Department of Cardiovascular Surgery, Heinrich-Heine University Medical Center, Düsseldorf, Germany
AIM: Extracorporeal life support (ECLS) is a potential life-saving technique for patients with cardiopulmonary collapse. Complications of this method include ischemia and bleeding of the lower extremity due to femoral cannulation of the groin. The purpose of this study was to evaluate whether ECLS is associated with the development of vascular complications and determine the risk factors for the development of lower extremity ischemia, bleeding and compartment syndrome of the leg.
METHODS: Emergency patients were supplied with ECLS outside the University of Düsseldorf and were recruited to the intensive care unit of the Department for Cardiovascular Surgery. One hundred patients were recruited between January 2009 and June 2014. Eighty-five patients received ECLS in emergency situations and were retrospectively evaluated for cannulation and perfusion strategy, morbidity, mortality, and lower limb ischemia. Risk factors were investigated, including age, gender, body surface area (BSA), Body Mass Index (BMI), duration of cardiopulmonary reanimation (CPR) until the implantation of ECLS, timespan between the implantation of the main retrograde arterial cannula and the antegrade arterial leg perfusion cannula and size of cannulae.
RESULTS: Eighty-five of one hundred patients received a cannulation of the groin in emergency situations for ECLS access of the femoral artery and vein. Of these patients, 62% (53/85 patients) received an antegrade perfusion cannula for the superficial femoral artery, which is supplied by a connection to the ECLS device. There was no difference in the development of limb ischemia caused by cannulation of the groin with regard to age, gender, BMI, BSA, CPR, size of cannula, comorbidities and mortality, but a statistical trend was observed for left-sided cannulation of the groin (P=0.095). This was significant for the timespan until implantation of the antegrade perfusion cannula for the superficial femoral artery (P<0.0001), development of compartment syndrome of the leg (P<0.0001) and bleeding of the cannulation site (P=0.037). Overall, the 30-day mortality after established ECLS therapy was 65%.
CONCLUSION: Patients receiving ECLS in emergency situations developed limb ischemia under specific conditions. This complication due to cannulation of the groin is not life-threatening but causes severe problems, such as compartment syndrome or bleeding. Prophylactic and prompt implantation of an antegrade perfusion cannula of the superficial femoral artery is mandatory for reperfusion of the leg and can avoid ischemia of the lower extremity.