Factors Associated with Ipsilateral Limb Ischemia in Patients Undergoing Femoral Cannulation Extracorporeal Membrane Oxygenation

Yau, Patricia; Yu, Xia; Shariff, Saadat; Jakobleff, William; Forest, S.; Lipsitz, Evan C.; Scher, Larry A.; Garg, Karan

doi:10.1016/j.avsg.2018.08.073

Cited by 44 publications

(31 citation statements)

References 17 publications

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“…Yau et al reported a hospital mortality of 82.4% in patients with acute limb ischemia, as opposed to 53.3% in those patients without, which was not statistically significant but showed a trend toward higher mortality (P ¼ 0.053). 16 Predisposing factors that correlated with limb ischemia in this study were younger age, diabetes, pulmonary disease, and peripheral arterial disease (PAD). Likewise, Lamb et al 17 noted a higher mortality in patients with limb ischemia, and Tanaka's group presented a strong association between vascular complications and hospital mortality.…”

Section: Discussionmentioning

confidence: 74%

See 1 more Smart Citation

The Effect of Acute Limb Ischemia on Mortality in Patients Undergoing Femoral Venoarterial Extracorporeal Membrane Oxygenation

Gulkarov

Bobka

Elmously

et al. 2020

Annals of Vascular Surgery

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Section: Discussionmentioning

confidence: 74%

“…4,7e17 A link between vascular complications and mortality is not fully established, and several studies failed to establish an association between ALI and mortality. 8,10,12,16 However, some of these reports have included a high percentage of venovenous ECMO cannulation, which may be a confounding variable.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Acute Limb Ischemia on Mortality in Patients Undergoing Femoral Venoarterial Extracorporeal Membrane Oxygenation

Gulkarov

Bobka

Elmously

et al. 2020

Annals of Vascular Surgery

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“…Considering the comorbidities, diabetes and respiratory diseases are independent risk-factors for limb ischemia during pV-A ECMO. Diabetes is characterized by a proinflammatory state, with macro- and micro-vascular alterations that can exacerbate limb hypoperfusion during a low flow state [12, 59]. Pulmonary diseases, such as asthma and chronic obstructive pulmonary disease (COPD), are characterized by a state of chronic hypoxia, which induces endothelial damage, inflammatory state, and development of atherosclerotic disease [60].…”

Section: Narrative Reviewmentioning

confidence: 99%

“…The emergent nature of the shock, as in cardiac arrest scenarios, and the faster and easier accessibility at the bedside, make the peripheral cannulation, and particularly the femoral vessels, the preferred site for percutaneous or surgical cutdown cannula insertion [9, 11]. However, arterial femoral cannulation can cause ipsilateral limb ischemia related to reduced blood flow and oxygen delivery to the distal leg below the insertion point of the cannula, with multiple mechanisms [9, 12–18].…”

Section: Introductionmentioning

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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“…23 Currently used cannulae are associated with several complications and disadvantages, which prolong applications. These include cannula thrombosis, 6,9,24 limb ischemia, 13,21,22,27,38,42,51 risk of dislocation, 21,38 infection of the cannulation site, 13,22,38 limitation of patient's mobility, 13,21,22,38 high effort of ambulation, 13,21,22,49 and arguably a low quality of life.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Venovenous Connection for Extracorporeal Carbon Dioxide Removal (ECCO2R)–Numerical Investigation of the Connection to the Common Iliac Veins

Steuer

Hugenroth

Beck

et al. 2020

Cardiovasc Eng Tech

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Purpose-Currently used cannulae for extracorporeal carbon dioxide removal (ECCO 2 R) are associated with complications such as thrombosis and distal limb ischemia, especially for long-term use. We hypothesize that the risk of these complications is reducible by attaching hemodynamically optimized grafts to the patient's vessels. In this study, as a first step towards a long-term stable ECCO 2 R connection, we investigated the feasibility of a venovenous connection to the common iliac veins. To ensure its applicability, the drainage of reinfused blood (recirculation) and high wall shear stress (WSS) must be avoided. Methods-A reference model was selected for computational fluid dynamics, on the basis of the analysis of imaging data. Initially, a sensitivity analysis regarding recirculation was conducted using as variables: blood flow, the distance of drainage and return to the iliocaval junction, as well as the diameter and position of the grafts. Subsequently, the connection was optimized regarding recirculation and the WSS was evaluated. We validated the simulations in a silicone model traversed by dyed fluid. Results-The simulations were in good agreement with the validation measurements (mean deviation 1.64%). The recirculation ranged from 32.1 to 0%. The maximum WSS did not exceed 5.57 Pa. The position and diameter of the return graft show the highest influence on recirculation. A correlation was ascertained between recirculation and WSS. Overall, an inflow jet directed at a vessel wall entails not only high WSS, but also a flow separation and thereby an increased recirculation. Therefore, return grafts aligned to the vena cava are crucial. Conclusion-In conclusion, a connection without recirculation could be feasible and therefore provides a promising option for a long-term ECCO 2 R connection.

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Factors Associated with Ipsilateral Limb Ischemia in Patients Undergoing Femoral Cannulation Extracorporeal Membrane Oxygenation

Cited by 44 publications

References 17 publications

The Effect of Acute Limb Ischemia on Mortality in Patients Undergoing Femoral Venoarterial Extracorporeal Membrane Oxygenation

The Effect of Acute Limb Ischemia on Mortality in Patients Undergoing Femoral Venoarterial Extracorporeal Membrane Oxygenation

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

Long-Term Venovenous Connection for Extracorporeal Carbon Dioxide Removal (ECCO2R)–Numerical Investigation of the Connection to the Common Iliac Veins

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