Does a distal perfusion cannula reduce ischaemic complications of <scp>extracorporeal membrane oxygenation</scp>?

LEUNG, R.; Huilgol, Ravi L.; Granger, Emily; Jackson, Andrew; Saling, Samantha; Dower, Ashraf; Nivison-Smith, Ian

doi:10.1111/ans.13441

Cited by 26 publications

(22 citation statements)

References 12 publications

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“…Patient numbers ranged from single‐patient case reports to 143 patients in one retrospective cohort study. Femoral arterial cannula size ranged from 12 to 24 Fr, while other studies described the choice as being based on patients' body surface area.…”

Section: Resultsmentioning

confidence: 99%

“…If arterial pressure 2–3 cm distal to the cannulation site, as measured with a 23G needle, was below 50 mm Hg, a DPC was placed. The other studies did not specify their selection criterion for DPC placement.…”

Section: Resultsmentioning

confidence: 99%

“…Among the included studies, 13 reported the incidence of limb ischemia in VA‐ECMO patients with DPC, including a total of 548 patients and 60 cases of limb ischemia, representing an incidence of 10.95%. Among these, nine studies reported the numerical incidence of their control groups in a manner sufficiently explicit for quantitative analysis (see Fig. ).…”

Section: Resultsmentioning

confidence: 99%

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Efficacy of Distal Perfusion Cannulae in Preventing Limb Ischemia During Extracorporeal Membrane Oxygenation: A Systematic Review and Meta‐Analysis

et al. 2017

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To date, no consensus exists regarding indication, technique, or efficacy of distal perfusion cannulae (DPC) in preventing limb ischemia among patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO). We aim to examine the available literature and report association between DPC and risk of limb ischemia. PubMed/Medline, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, and bibliographies of included studies were searched from database inception until August 2016. Original studies describing the DPC placement technique and incidence of limb ischemia following DPC placement among VA-ECMO patients were included for systematic review. Studies with a comparison group of patients without DPC were included for meta-analysis. Two authors independently screened title/abstracts, reviewed full texts, and extracted data from the eligible studies. Meta-analysis was performed using the Mantel-Haenszel method under a random-effects model. Statistical heterogeneity was examined with the I2 statistic (RevMan Version 5.3). Of 542 title/abstracts screened, 62 full text articles were selected for review, yielding 22 retrospective observational studies, for a total of 779 patients with 132 limb ischemia events. There was significant variation in DPC indication, cannula type, and placement technique among the studies. Compared to no DPC, the presence of a DPC was associated with at least a 15.7% absolute reduction in the incidence of limb ischemia (9.74 vs. 25.42%; risk ratio 0.41; 95% confidence interval 0.26-0.65, P < 0.01; heterogeneity statistic I2 = 28%). There was no statistically significant difference in mortality in the pooled dataset comparing DPC versus no DPC. In adults treated with VA-ECMO, DPC placement was associated with a lower incidence of limb ischemia. Currently no consensus guidelines exist regarding indication for DPC placement. Given the association described in this analysis, future prospective trials are warranted to establish a causal relationship and optimal technique for the use of DPC in patients treated with VA-ECMO.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Efficacy of Distal Perfusion Cannulae in Preventing Limb Ischemia During Extracorporeal Membrane Oxygenation: A Systematic Review and Meta‐Analysis

et al. 2017

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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 Cmentioning

confidence: 82%

“…Some authors do not use it systematically but only expectantly, as they did not find a statistically significant difference with respect to mortality or limb ischemia in comparing a systematic and an expectant approach (27,31). Others implant the distal reperfusion only if the mean pressure in the superficial femoral artery 2 to 3 cm distal to the cannulation site is below 50 mmHg after ECLS initiation (33).…”

Section: A B Cmentioning

confidence: 99%

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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Complications of mechanical circulatory and respiratory support

Burrell

Salamonsen

Murphy

2018

Mechanical Circulatory and Respiratory Support

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Does a distal perfusion cannula reduce ischaemic complications of extracorporeal membrane oxygenation?

Cited by 26 publications

References 12 publications

Efficacy of Distal Perfusion Cannulae in Preventing Limb Ischemia During Extracorporeal Membrane Oxygenation: A Systematic Review and Meta‐Analysis

Efficacy of Distal Perfusion Cannulae in Preventing Limb Ischemia During Extracorporeal Membrane Oxygenation: A Systematic Review and Meta‐Analysis

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

Complications of mechanical circulatory and respiratory support

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