Immunocompetence Status as Related to Infection in Heart Transplants after Ventricular Assist Device Implantation

Abstract

Purpose: Extracorporeal membrane oxygenation (ECMO) is a temporary mechanical circulatory assist method that offers circulatory as well as respiratory support efficiently via peripheral access; however, it is liable to a lot of complications. Limb ischemia, besides blood loss and infections, is one of the complications of ECMO but can be avoided utilizing a proper distal limb perfusion. Methods: We retrospectively reviewed 108 (56,4±14,9y) of our patients that went in need of veno-arterial extracorporeal life support in the University Hospital of Hamburg in the time between January 2014 until June 2015. Results: The 108 patients received a femoral access to establish a sufficient blood flow, using a venous multistage cannula and arterial cannulation between 15 and 20 french. Distal limb perfusion was achieved with an introducer sheath (6-8 Fr) attached to the side-port of the arterial cannula in 53 cases. 10 (9,5%) patients developed signs of ischemia; four (3,7%) suffered from compartment syndrome in the leg containing the cannula and were in need of surgical treatment including fasciotomy, two patients required a below-knee amputation. The incidences of limb ischemia and limb ischemia requiring surgical intervention were significantly higher for the patients without distal leg perfusion compared to the patients treated with perfusion. (16,4% vs. 1,9% (p= 0,01) and 7,3% vs. 0% (p 0,04)). Increasing the diameter of the sheath showed no significant effect on the outcome, as well as the diameter of the arterial cannula, which was chosen between 15-19 Fr. None of the patients developing a compartment-syndrome with the need of surgical intervention survived the hospital stay. Conclusion: Use of distal perfusion helps to reduce one of the versatile complications patients suffer of in need of extracorporeal life support. Limb ischemia could be reduced significantly using an introducer sheath. Use of a distal-perfusion is a most reliable method of limb perfusion in peripheral VA-ECMO and should be established in every patient.