RF91 USE OF NIRS AND REFLECTANCE PULSE OXIMETRY AS A MONITORING IN DISTAL PERFUSION OF THE LIMB DURING PERIPHERAL ECMO.

Abstract

Background and aim: One of the biggest complications in patients treated with venoarterial ECMO is lower extremity ischemia, site of the peripheral cannulation. The ELSO database reports a 5% incidence of ischemic leg complications in patients with peripheral va-ECMO, leading to leg amputation in 1% of cases. The objective of the study is to optimize the perfusion of the cannulated limb for the reduction of the incidence of ischemia, pacing a distal perfusion catheter (8 Fr) in the superficial femoral artery, before the insertion of the deep femoral artery and monitoring of tissue oxygen saturation by NIRS and reflectance pulse oxymetry. Methods: Our study includes the analysis of the experience on a group of 9 patients in which tissue saturation was monitored by NIRS (group A) and another group that includes patients on whom the distal flow of the limb has been periodically detected by Eco Doppler SD2, without monitoring of tissue saturation (group B). Results: In the experience of group B a late diagnosis of ischemia of the cannulated limb was found despite the distal perfusion. In group A NIRS monitoring allowed to readily diagnose a hypoperfusion, detected with a variation of saturation > 10% with respect to the tissue saturation of the contralateral limb and the basal value, resolving it with the immediate repositioning distal perfusion cannula. Conclusions: We conclude that transcutaneous NIRS and reflectance pulse oximetry may be an effective non-invasive method for continuous monitoring of leg perfusion in patients treated with peripheral ECMO and distal limb reperfusion.