Abstract

BackgroundFemoral arterial cannulation to initiate veno-arterial ECMO may result in ipsilateral limb ischemia due to reduced distal blood flow below the insertion point of the cannula. We retrospectively studied adult patients supported with femoral VA-ECMO for cardiogenic shock between 2015 and 2019 at our tertiary care hospital.ResultsThe study included 65 adult patients supported with femoral VA-ECMO for refractory cardiogenic shock. The studied patients had a mean age of 37.9 ± 14.87 years, mostly males (70.8%), a mean BSA of 1.77 ± 0.27 m2, and a mean BMI of 26.1 ± 6.7 kg/m2. Twenty-one (32.3%) patients developed acute lower limb ischemia. The patients who developed acute limb ischemia had significantly frequent AKI (< 0.001) without significant use of haemodialysis (p = 0.07) and longer ICU stay (p = 0.028) compared to the patients without limb ischemia. The hospital mortality occurred in 29 (44.6%) patients without significant difference between the patients with and without acute limb ischemia. The occurrence of acute limb ischemia was significantly correlated with failed percutaneous cannulation (p = 0.039), while there was no significant statistical correlation between the cut-down technique and occurrence of limb ischemia (p = 0.053). The occurrence of femoral cannulation site bleeding was significantly correlated with failed percutaneous cannulation (p = 0.001) and cut-down technique (p = 0.001).ConclusionAcute vascular complications are frequent after femoral VA-ECMO. Failed percutaneous femoral cannulation has been, in this study, identified as the most important risk factor for acute limb ischemia and cannulation site bleeding. A careful approach during femoral cannulation is recommended to prevent occurrence of acute limb ischemia and femoral cannulation site bleeding.

Highlights

  • Femoral arterial cannulation to initiate veno-arterial ECMO may result in ipsilateral limb ischemia due to reduced distal blood flow below the insertion point of the cannula

  • Baseline clinical variables of studied patients The study included 65 adult patients supported with femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock

  • The occurrence of femoral cannulation site bleeding was significantly correlated with failed percutaneous cannulation (p = 0.001) and cut-down technique (p = 0.001)

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Summary

Introduction

Femoral arterial cannulation to initiate veno-arterial ECMO may result in ipsilateral limb ischemia due to reduced distal blood flow below the insertion point of the cannula. We retrospectively studied adult patients supported with femoral VA-ECMO for cardiogenic shock between 2015 and 2019 at our tertiary care hospital. Emergent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to provide rapid cardiopulmonary resuscitation in adult patients with refractory cardiogenic shock [1,2,3]. The emergent nature of the haemodynamics deterioration, as in cardiac arrest or post-cardiotomy shock conditions, makes. Laimoud et al The Egyptian Heart Journal (2021) 73:15. ECMO in the adult patients with cardiogenic shock in our tertiary care hospital

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