Contralateral Lower Extremity Ischemia on Femoral Veno-Arterial Extracorporeal Membrane Oxygenation

Arons, Danielle; Dave, Sagar; Shah, Aakash; Deatrick, Kristopher B.

doi:10.1097/mat.0000000000001832

Cited by 3 publications

(2 citation statements)

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“…A prospective trial found an incidence of critical limb ischemia of 38% in patients with refractory cardiogenic shock supported with VA-ECMO [ 19 ]. ALI can lead to further complications and negatively affect patients’ survival [ 3 ]. The use of a DPC aims at avoiding ALI, but its efficiency has not yet been proven, and up to 26% of patients under VA-ECMO experience ALI despite the use of a DPC [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ipsilateral ALI occurs in 11 to 52% of VA-ECMO cases and can lead to further complications, including compartment syndrome requiring fasciotomy, functional deficit, or amputation of the lower limb. ALI carries a higher risk of a lethal outcome than other complications of VA-ECMO [ 3 ]. The burden of ALI might even counterbalance the physiological benefit of ECMO and hinder the survival benefit of this technique [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Preventing Acute Limb Ischemia during VA-ECMO—In Silico Analysis of Physical Parameters Associated with Lower Limb Perfusion

Brockaert,

Ferreira,

Laplante

et al. 2023

JCM

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Background: Peripheral femoro-femoral veno-arterial extracorporeal membrane oxygenation is increasingly used in refractory cardiogenic shock. However, the obstruction of the femoral artery by the return cannula could lead to acute limb ischemia, a frequently encountered situation that is inconstantly prevented by the adjunction of a distal perfusion cannula (DPC). The aim of this study was to investigate the influence of three physical parameters on the perfusion of the cannulated lower limb. Methods: Using patient-specific arterial models and computational fluid dynamic simulations, we studied four diameters of arterial cannula, three diameters of DPC, and two percentages of arterial section limitation. Results: We found that adequate perfusion of the cannulated limb was achieved in only two out of the twenty-one configurations tested, specifically, when the arterial cannula had a diameter of 17 Fr, was considered to limit the section of the artery by 90%, and was associated with an 8 Fr or a 10 Fr DPC. Multivariable analysis revealed that the perfusion of the cannulated lower limb was correlated with the diameter of the DPC, but also with the diameter of the arterial cannula and the percentage of arterial section limitation. Conclusions: In most of the cases simulated here, the current system combining unsized arterial cannula and non-specific DPC was not sufficient to provide adequate perfusion of the cannulated lower limb, urging the need for innovative strategies to efficiently prevent acute limb ischemia during peripheral femoro-femoral veno-arterial extracorporeal membrane oxygenation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%