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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2016 Gennaio;82(1):36-43
Early vascular complications after percutaneous cannulation for extracorporeal membrane oxygenation for cardiac assist
Leonello AVALLI 1, Fabio SANGALLI 1, Maurizio MIGLIARI 1, Elena MAGGIONI 1, Simona GALLIERI 2, Vittorio SEGRAMORA 3, Valter CAMESASCA 3, Francesco FORMICA 4, Giovanni PAOLINI 4, Antonio PESENTI 1, 2 ✉
1 Department of Emergency and Urgency, San Gerardo Hospital, Monza, Italy; 2 Department of Health Sciences, University Milano-Bicocca, San Gerardo Hospital, Monza, Italy; 3 Vascular Surgery Clinic, San Gerardo Hospital, Monza, Italy; 4 Cardiac Surgery Clinic, Department of Surgery and Traslational Medicine, University Milano-Bicocca, San Gerardo Hospital, Monza, Italy
BACKGROUND: Extracorporeal membrane oxygenation (VA ECMO) demonstrated an advantage in survival and neurological outcome in patients with cardiogenic shock and, in selected population, in victims of refractory cardiac arrest. The incidence of vascular complications ranges in recent series from 10 to 70% including both early and late complications. The aim of the present study was to determine the incidence of early vascular complications and the effectiveness of the prevention of limb ischemia by the insertion of a catheter for distal perfusion.
METHODS: Data from our registry of 100 patients treated with VA ECMO implanted via percutaneous femoral approach for cardiogenic shock or refractory cardiac arrest were analyzed. If the leg perfusion was inadequate, an additional 7-9 Fr percutaneous catheter distal to the ECMO arterial cannula was placed into the femoral artery to prevent limb ischemia.
RESULTS: Thirty-five patients had early vascular complications. Thirty patients with early ischemia were cannulated with a small reperfusion cannula to obtain antegrade perfusion of the limb. Twenty-six had an effective reperfusion. Seven patients developed a compartment syndrome of the leg requiring urgent fasciotomy that led to clinical improvement and recovery in five, while the other two patients progressed to irreversible ischemia requiring amputation of the limb.
CONCLUSION: The majority of ischemic episodes were resolved with the insertion of a distal perfusion catheter. We did not observe any mortal vascular complication, nor any of the observed complications was related to increased mortality.