Is Lower Limb Venous Drainage During Peripheral Extracorporeal Membrane Oxygenation Necessary?

Abstract

Extracorporeal membrane oxygenation (ECMO) is becoming a gold standard in acute heart failure, not responsive to inotrops and intra-aortic balloon contrapulsation. This diffusion is due to the possibility to implant it through peripheral cannulation and to perform long-time assistance. Nevertheless, this technique implies some problems concerning inferior limb perfusion. It is widely accepted that arterial distal cannulation and perfusion of the limb is mandatory, especially for long periods of assistance; but the necessity to implant a distal venous drainage is still discussed. We would like to present our experience on peripheral ECMO where we could avoid venous distal drainage uneventfully.

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

“…The majority of studies did not report on the association between mortality and DPC or vascular complications. Four studies inferred no statistical significant association between mortality and either DPC or vascular complications. Four studies described the association between limb ischemia and mortality.…”

“…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.…”

“…DPC were used both as a prophylaxis to prevent limb threat and as rescue for ongoing ischemia. Nine studies described routine prophylactic insertion of DPCs, while two used DPCs in response to signs of inadequate leg perfusion during physical or ultrasonographic Doppler examination. One study compared the two indications for DPC use and found 0/44 and 10/107 instances of limb ischemia in prophylactic and rescue groups, respectively.…”

“…The most common DPC types were central venous catheters and vascular introducer sheaths , although use of pediatric arterial catheters , coronary cannula to percutaneous venous catheters have all been reported in sizes from 5 to 14 Fr. Mohite et al were the only group that investigated the efficacy of a pediatric Bio‐Medicus cannula (Medtronic, Minneapolis, MN, USA) versus an introducer sheath and found the incidence of both limb ischemia and severe limb ischemia requiring surgical intervention to be higher with the introducer sheath (30.6% vs. 15.6% and 15.4% vs. 6.25%, respectively).…”

“…While the use of DPCs in VA‐ECMO patients was described two decades ago, its application remains controversial. Many institutions have adopted a pre‐emptive DPC paradigm , while others are hesitant due to the perceived risks of an additional interventional procedure (11,22). In our study, we found that a significantly lower risk of limb ischemia was found among patients with DPC versus patients without DPC.…”