Incidence and risk factors of groin lymphocele formation after venoarterial extracorporeal membrane oxygenation in cardiogenic shock patients

Salna, Michael; Takayama, Hiroo; Garan, A.R.; Kurlansky, Paul; Farr, Maryjane; Colombo, P.C.; Imahiyerobo, Thomas; Morrissey, Nicholas J.; Naka, Yoshifumi; Takeda, Koji

doi:10.1016/j.jvs.2017.05.127

Cited by 23 publications

(35 citation statements)

References 30 publications

(37 reference statements)

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“…:LI group n = 46No LI group n = 93Identify pre-cannulation variables that are associated with limb ischemia and selection criteria for using DPC for prevention of limb ischemiaNo LI group:DM 16 (17%)HT 28 (30%)Uremia 10 (11%)PVD 8 (9%)LI group:DM 10 (22%)HT 17 (37%)Uremia 8 (17%)PVD 11 (24%)NANo LI group: 69 (74%)LI group: 25 (54%)16.5 ± 0.8PCNA46 (33%)Rescue6 FrNABurrell, 2018 [26]R144 ptsComplications and outcomes of patients who were commenced on ECMO at a referring hospital compared with patients who had ECMO in a referral center for ECMO.S 35 (26%)CAD 35 (26%)DM 16 (12%)HF 69 (53%)CT 18 (13%)7 (4–11) days105 (72.9%)17–19 FrPCNA1 (0.7%)Pre-emptive9 FrResolved after DPC insertion at the referral centerVoicu, 2018 [27]R46 pts. with refractory CAAnalyze the feasibility and the time interval required for percutaneous cannulation versus anatomic landmark cannulation for va ECMO.S 21 (46%)DM 5 (11%)HT 17 (37%)HL 15 (33%)NA4 (9%)15–17-19 FrPCNA0Pre-emptive4 FrNASalna, 2018 [28]R192 pts. with CS:35% AMI23% PCS18% ADHF15% PGD8.9% otherIncidence of in-hospital lymphocele formation in VA-ECMO patients and identify predictors for its developmentDM 65 (33.9%)CKD 52 (27.1%PVD 19 (9.4%)4 (2–6) days120 (62.5%)15–17 FrSCD 88 (45.8%)Surgical16 (8.3%)Preventive based on Doppler signal at cannulation6–10 FrNALamb, 2017 [29]R91 patients:CS 73 (80%);ARF 14 (15%)PE 3 (4%)VAD failure 1 (1%)Evaluation of an ischemia prevention protocolHT 53 (58%)DM 26 (29%)HL 34 (37%)OB 30 (33%)CLD 15 (17%)PVD 6 (7%)CKD 27 (30%)9 days38 (42%)16-24 Fr on pressure-flow curve and pts.…”

Section: Methodsmentioning

confidence: 99%

Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment

et al. 2019

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Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is an increasingly adopted life-saving mechanical circulatory support for a number of potentially reversible or treatable cardiac diseases. It is also started as a bridge-to-transplantation/ventricular assist device in the case of unrecoverable cardiac or cardio-respiratory illness. In recent years, principally for non-post-cardiotomy shock, peripheral cannulation using the femoral vessels has been the approach of choice because it does not need the chest opening, can be quickly established, can be applied percutaneously, and is less likely to cause bleeding and infections than central cannulation. Peripheral ECMO, however, is characterized by a higher rate of vascular complications. The mechanisms of such adverse events are often multifactorial, including suboptimal arterial perfusion and hemodynamic instability due to the underlying disease, peripheral vascular disease, and placement of cannulas that nearly occlude the vessel. The effect of femoral artery damage and/or significant reduced limb perfusion can be devastating because limb ischemia can lead to compartment syndrome, requiring fasciotomy and, occasionally, even limb amputation, thereby negatively impacting hospital stay, long-term functional outcomes, and survival. Data on this topic are highly fragmentary, and there are no clear-cut recommendations. Accordingly, the strategies adopted to cope with this complication vary a great deal, ranging from preventive placement of antegrade distal perfusion cannulas to rescue interventions and vascular surgery after the complication has manifested. This review aims to provide a comprehensive overview of limb ischemia during femoral cannulation for VA-ECMO in adults, focusing on incidence, tools for early diagnosis, risk factors, and preventive and treating strategies.

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Section: Methodsmentioning

confidence: 99%

Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment

et al. 2019

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“…Cardiac transplant patients on Tacrolimus -an immunosuppressant associated with the incidence of post-transplant diabetes -have an strong association to this complication; its incidence was significantly influenced by primary graft dysfunction. The authors note that lymphocele formation in these patients is probably due to the combination of manipulation of the femoral arteries in patients with diabetes, and high doses of immunosuppressants (33) . Therefore, when caring for transplanted patients during ECMO, the surveillance for this occurrence, persistence, volume, and infectious characteristics of possible inguinal drainage should and must be intensified.…”

Section: Predictors Of Complications Associated With Extracorporeal Mmentioning

confidence: 96%

“…The chance of severe thrombocytopenia increases by 35% with each 5 points increase in the APACHE II score, and each decrease in the platelet count of 25,000/μL from 188,000/μL after cannulation (19) . Primary cardiac graft dysfunction among transplanted individuals was associated with an 8.66 time increase in the chance of lymphocele (33) . For venous thromboembolism and venous thrombosis, one extra day in ECMO increases the chance by 4%, while a PTT > 50 sec decreases the chance by 3% (34) .…”

Section: Sample/ecmo Modality Objective Findings/multivariate Analysimentioning

confidence: 97%

“…Neurological complications were the most frequently investigated (seven studies) (17)(18)(21)(22)(23)27,30) , followed by hemorrhagic (three studies) (24,29,32) , kidney (two studies) (26,31) , infectious (two studies) (20,25) , and mechanical (one study) (16) complications. Other complications were identified in the studies and were categorized as "other": formation of a lymphocele (one study) (33) , thrombocytopenia (one study) (19) , and thrombosis or pulmonary thromboembolism (one study) (34) .…”

Section: Sample/ecmo Modality Objective Findings/multivariate Analysimentioning

confidence: 99%

“…The frequent complications included: neurological (5.2%-15.1%) (17)(18)(21)(22)23,27,30) , bleeding (17%-80%) (24,29,32) , infection (21.4%-23.0%) (20,25) , kidney complications (48.8%-73%) (26,31) , lymphocele formation (16% in the total sample, in which 93.5% received heart transplants) (33) , thrombocytopenia (22%) (19) , and thrombosis or pulmonary thromboembolism (34) .…”

Section: Sample/ecmo Modality Objective Findings/multivariate Analysimentioning

confidence: 99%

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Predictors of complications associated with extracorporeal membrane oxygenation

Nakasato

Lopes

2020

Rev. Bras. Enferm.

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Objectives: to identify in the literature, the predictors of ECMO complications in adult patients. Methods: integrative review of literature, including articles in Portuguese, English and Spanish published from 2014 to 2018 in five databases. Included articles which analyzed the predictive factors of ECMO complications in adult patients using multivariate analysis. Results: a total of 1629 articles were identified, of which 19 were included. Nineteen predictors were identified for neurological complications (e.g., post-ECMO hypoglycemia), seven for bleeding complications (e.g., fungal pneumonia), four for infections complications (e.g., preoperative creatinine level), three for kidney complications (e.g., the length of ICU stay> 20 days) and a combination of factors for mechanical complications (e.g., median flow). Conclusions: different predictors were identified to ECMO complications. The knowledge of these predictors enables the individualized targeting of preventive interventions by multidisciplinary team for modifiable factors, as well as intensification of monitoring for early recognition of non-modifiable factors.

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Percutaneous decannulation of extracorporeal membrane oxygenation using a plug‐based closure device

Dalén

Settergren

Kastengren

et al. 2022

Cathet Cardio Intervent

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Background: There is limited experience of using the MANTA plug-based vascular closure device for percutaneous arterial closure of the femoral artery after venoarterial extracorporeal membrane oxygenation. Objectives: To study femoral artery complications and need for subsequent vascular interventions after percutaneous decannulation of venoarterial extracorporeal membrane oxygenation (VA ECMO) using the MANTA plug-based vascular closure device. Methods: We studied 34 consecutive patients who underwent percutaneous decannulation of VA ECMO using the MANTA device. Primary outcomes were conversion to surgical cutdown of the groin at decannulation (immediate) or later. Secondary outcomes were type of vascular complication necessitating conversion to surgical cutdown of the groin. Results: Six (17.7%) patients had to undergo immediate (n = 3) or late (n = 3) conversion to surgical cutdown of the groin. Of these, three were owing to occlusion of the common femoral artery resulting in insufficient distal perfusion and three owing to bleeding or pseudoaneurysm. The mechanism of failure was complete intravascular deployment of the MANTA device in three patients, incomplete MANTA sealing of the arteriotomy in one patient, MANTA-unrelated thrombotic occlusion in one patient, and unknown in one patient. Surgical cut-down was typically performed with concomitant catheter thrombectomy with or without patch reconstruction of the artery. Conclusion: Percutaneous decannulation of VA ECMO using the MANTA VCD was feasible but a substantial number of patients needed to be converted to unplanned surgical repair, owing to either closure site-located stenosis/occlusion or bleeding. If suboptimal MANTA positioning is suspected, a low threshold for conversion to surgical cutdown of the groin is recommended.

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Incidence and risk factors of groin lymphocele formation after venoarterial extracorporeal membrane oxygenation in cardiogenic shock patients

Abstract: Lymphocele formation is relatively common after femoral VA-ECMO. There was a significantly higher incidence of lymphocele formation in diabetic patients requiring support for PGD after heart transplantation.

Cited by 23 publications

References 30 publications

Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment

Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment

Predictors of complications associated with extracorporeal membrane oxygenation

Percutaneous decannulation of extracorporeal membrane oxygenation using a plug‐based closure device

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