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International Angiology 2020 Sep 30

DOI: 10.23736/S0392-9590.20.04408-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Distal perfusion cannulae reduce ECMO-related limb ischemia

Stephen C. HANLEY, Raffi MELIKIAN, William C. MACKEY, Payam SALEHI, Mark D. IAFRATI, Luis SUAREZ

Division of Vascular Surgery, Tufts Medical Center, Boston, MA, USA


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BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a means of providing cardiopulmonary support that is being increasingly used in patients with acute heart failure. When ECMO cannulae are placed peripherally, their large diameters pose a risk of limb ischemia. Distal perfusion cannulae (DPC) have been proposed as means to reduce risk, but their use is not recommended by the most recent ECMO guidelines. We sought to establish their utility at our institution.
METHODS: We performed a retrospective review of of all patients treated with peripheral VAECMO at our institution from 2013-2018. During the first 2 years, DPC were not routinely placed, whereas in the final 4 years, DPC were recommended as part of the ECMO cannulation routine.
RESULTS: 101 patients were treated with peripheral VA-ECMO, with an overall mortality of 61%. By univariate analysis, obesity (47 vs 75%, p<.01) and limb ischemia (57 vs 83%, p<.05) were associated with increased mortality. DPC were placed prophylactically in 49% of patients. Prophylactic placement of a DPC at the time of cannulation significantly reduced the incidence of limb ischemia (2 vs 32%, p<.05), but didn’t impact mortality (53 vs 69%, p=.0953). In patients who didn’t have a DPC placed during ECMO cannulation and subsequently developed limb ischemia, late DPC placement for limb salvage didn’t impact mortality.
CONCLUSIONS: Limb ischemia portends a poor outcome in VA-ECMO patients, and prophylactic DPC placement significantly reduces the risk of limb ischemia. We propose prophylactic DPC placement be considered in patients requiring peripheral VA-ECMO.


KEY WORDS: Extracorporeal membrane oxygenation; Surgery; Cannula

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