Limb ischemia and bleeding in patients requiring venoarterial extracorporeal membrane oxygenation

ObjectiveAcute limb ischemia (ALI) and cannulation site bleeding are frequent complications of venoarterial (VA) extracorporeal membrane oxygenation (ECMO) associated with worse outcomes. The goals this study were to assess our rates ECMO-related ALI evaluate the efficacy strategies prevent them, such as distal perfusion cannula (DPC) ultrasound-guided cannulation.MethodsThis is a single-center retrospective cohort adult patients placed on peripheral VA-ECMO at tertiary medical center between 2014 2018. was defined new extremity ipsilateral arterial cannulation. Significant excessive requiring intervention (eg, transfusion or reoperation). Univariate analyses used identify factors ALI, bleeding, in-hospital mortality.ResultsDuring period, 105 (61.3% female; mean age, 54.9 ± 14.8 years). Nearly half (46.6%) had ECMO implantation in an cardiopulmonary resuscitation setting 37 (44.0%) DPC. Average duration support 5.6 5.0 days. Overall mortality death 65.1% 50%, respectively. occurred 21 (20%) cannulation-related 24 (22.9%) who treated total 27 procedures, including thromboembolectomy (22.2%), vascular repair (18.5%), fasciotomy (25.9%). On univariate analysis, operating room (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.08-0.77; P = .02) decreased risk whereas (OR, 2.65; CI, 1.09-6.45; .03) cutdown approach 4.96; 2.32-10.61; < .0001) increased bleeding. Ultrasound-guided placement 0.81; 0.04-0.84; .03). DPC not either (P .47) .06). 2.68; CI 1.03-6.98; .04), age 1.94; 1.03-3.69; baseline heart failure 2.01; 1.02-3.97; .04) greater mortality. 0.41; 0.20-0.87; mortality.ConclusionsALI significant common occurrences after Whereas did significantly decrease Cannulation expense older (≥65 years),