Arterial Complications in Patients Undergoing Extracorporeal Membrane Oxygenation via Femoral Cannulation

Aziz, Faisal; Brehm, Christoph; El-Banyosy, Aly; Han, David C.; Atnip, Robert G.; Reed, Amy B.

doi:10.1016/j.avsg.2013.03.011

Cited by 99 publications

(84 citation statements)

References 17 publications

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“…This incidence was obviously higher than that reported in the literature with a rate of arterial complications of 10-20% (27)(28)(29)(30)(31)(32). The physiopathology of ipsilateral limb ischemia in patients supported with ECLS through a femoral cannulation is multifactorial and various predictors were identified over time such as younger age, pre-existing peripheral arterial disease and the absence of a distal perfusion catheter (27,28,30).…”

Section: A B Ccontrasting

confidence: 44%

High rate of arterial complications in patients supported with extracorporeal life support for drug intoxication-induced refractory cardiogenic shock or cardiac arrest

Pozzi¹,

Koffel²,

Djaref³

et al. 2017

J. Thorac. Dis.

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Background: Cardiac failure is still a leading cause of death in drug intoxication. Extracorporeal life support (ECLS) could be used as a rescue therapeutic option in patients developing refractory cardiogenic shock or cardiac arrest. The aim of this report is to present our results of ECLS in the setting of poisoning from cardiotoxic drugs. Methods: We included in this analysis consecutive patients who received an ECLS for refractory cardiogenic shock or in-hospital cardiac arrest due to drug intoxication. The primary endpoint of our study was survival to hospital discharge with good neurological recovery after ECLS support. Results: Between January 2010 and December 2015, we performed 12 ECLS. Mean age was 44.2±17.8 years and there was a predominance of females (66.7%). Drug intoxication was mainly due to beta-blockers and/or calcium channel inhibitors (83.3%) and 5 (41.7%) patients had multiple drugs overdose. Weaning rate and survival to hospital discharge with good neurological recovery were 75% (9 patients). Among patients weaned from ECLS, mean duration of support was 2.4±1.1 days. Three (25%) patients underwent ECLS implantation during cardiopulmonary resuscitation, 2 (66.6%) of them died while on mechanical circulatory support (MCS). Six (50%) patients developed lower limb ischemia. Each patient was managed with ECLS decannulation: 2 (16.7%) patients underwent a concomitant iliofemoral thrombectomy, 3 (25%) needed further fasciotomy and the remaining patient (8.3%) required an amputation. Conclusions: Refractory cardiogenic shock due to drug intoxication is still one of the best indications for ECLS owing to the satisfactory survival with good neurological outcome in such a critically ill population.Further data are however necessary in order to best understand the possible relation between drug intoxication and lower limb ischemia, which was quite superior to the reported rates.

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Section: A B Ccontrasting

confidence: 44%

High rate of arterial complications in patients supported with extracorporeal life support for drug intoxication-induced refractory cardiogenic shock or cardiac arrest

Pozzi¹,

Koffel²,

Djaref³

et al. 2017

J. Thorac. Dis.

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“…There is limited data regarding the influence of vascular complications of ECMO on outcomes (11,12). Bisdas and colleagues concluded that there was no significant difference in mortality between patients with and without vascular complications (11).…”

Section: Commentmentioning

confidence: 99%

“…The most common cannulation technique for adults requiring Venoarterial (VA) ECMO is percutaneous, via the femoral vessels because of their size and accessibility (4,5). However, vascular complications related to femoral cannulation are one of the most common and serious complications of ECMO (6)(7)(8)(9)(10)(11)(12). Leg ischemia is particularly worrisome and a distal perfusion catheter is often placed to prevent ischemia (13,14).…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Vascular Complications on Survival of Patients on Venoarterial Extracorporeal Membrane Oxygenation

Tanaka

Hirose

Cavarocchi

et al. 2016

The Annals of Thoracic Surgery

142

124

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“…The prevalence of ischemic sequelae in such patients is 40% to 70%. [2][3][4][5] In these instances, limb ischemia can be avoided in multiple ways. A small sheath can be placed in the superficial FA to maintain antegrade distal-limb perfusion.…”

Section: Discussionmentioning

confidence: 99%

Modified T-Graft for Extracorporeal Membrane Oxygenation in a Patient with Small-Caliber Femoral Arteries

Calderon¹,

El‐Banayosy²,

Koerner³

et al. 2015

Texas Heart Institute Journal

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Extracorporeal membrane oxygenation (ECMO) is generally used as a last resort toE xtracorporeal membrane oxygenation (ECMO) is a short-term mechanical circulatory support system for patients who are in advanced cardiac, pulmonary, or combined cardiopulmonary failure. Patients in cardiac failure are typically placed on venoarterial ECMO, and patients in respiratory failure are placed on venovenous ECMO. Large-diameter cannulas are needed to maintain high blood flow through the mechanical circulatory support system. However, upon insertion into blood vessels, these cannulas can reduce native blood flow, especially when vessel diameters are small. Acute limb ischemia can necessitate vascular reconstruction or amputation of the patient's extremities. We describe a modified T-graft technique that we used in order to avoid acute limb ischemia from ECMO in a young woman whose femoral arteries (FAs) were small. Case ReportIn April 2012, an 18-year-old woman presented with viral cardiomyopathy, systolic heart failure, and acute respiratory distress syndrome. She was intubated and was started on full mechanical ventilation. However, her pulmonary status continued to deteriorate, so we emergently placed her on ECMO. A 15F cannula was inserted in her right common FA, and a 19F cannula was inserted in her right common femoral vein. Several attempts to percutaneously place an antegrade distal-perfusion catheter in the right superficial FA failed because of small vessel size (diameter, 3-4 mm) and vasoconstriction. Critical limb ischemia subsequently developed in the patient's right leg. She remained hemodynamically unstable and would not have been able to tolerate a limb-revascularization procedure. During the next few days, her hemodynamic status improved; however, she became increasingly acidotic and sustained rhabdomyolysis and renal failure as the limb ischemia progressed. To prevent progression of the renal failure secondary to rhabdomyolysis, an emergency guillotine amputation of her right leg was performed, above the knee. At the same time, we decided to switch the ECMO to left femoral access by means of a modified T-graft technique, to avoid critical limb ischemia of her left leg.

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Arterial Complications in Patients Undergoing Extracorporeal Membrane Oxygenation via Femoral Cannulation

Cited by 99 publications

References 17 publications

High rate of arterial complications in patients supported with extracorporeal life support for drug intoxication-induced refractory cardiogenic shock or cardiac arrest

High rate of arterial complications in patients supported with extracorporeal life support for drug intoxication-induced refractory cardiogenic shock or cardiac arrest

The Impact of Vascular Complications on Survival of Patients on Venoarterial Extracorporeal Membrane Oxygenation

Modified T-Graft for Extracorporeal Membrane Oxygenation in a Patient with Small-Caliber Femoral Arteries

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