Y. Sanaiha1, G. R. Ramos1, Y. Juo1, J. C. Jimenez1, P. B. Benharash1 1David Geffen School Of Medicine,Division Of General Surgery,Los Angeles, CA, USA
Introduction: Despite advances in cannulation technique, venoarterial (VA) Extracorporeal Membrane Oxygenation (ECMO) is still associated with near 15% incidence of acute limb ischemia (ALI) requiring interventions such as amputation. Distal perfusion catheters (DPCs) have been used to provide antegrade flow to the distal extremity, and can be placed preemptively or in response to signs of limb ischemia. However, the efficacy of DPCs in reducing incidence of vascular complications is not well-established. The present study aims to evaluate the impact of DPC on ALI incidence and mortality.
Methods: The institutional ECMO database was used to identify all adult patients who underwent VA-ECMO between January 2013 to June 2016. Demographic, technical, and clinical outcomes data were collected. Acute limb ischemia was defined as skin mottling on exam, loss of pulses, or tissue loss. Interventions included thombectomy, fasciotomy or amputation.
Results: During the study period, 103 adult ECMO patients met inclusion criteria and were included for analysis. Indications for ECMO were cardiogenic shock in 46.6%, cardiac arrest in 24.3%, post-cardiotomy syndrome in 16.5%, transplant rejection in 4.5%, and severe respiratory failure in 7.8%. 51 patients received DPCs as a preemptive measure and 1 patient received DPC as a therapeutic measure. Overall, 28 (34.1%) patients experienced ALI, with 15 (18.2%) patients requiring surgical intervention. Patients who received DPCs had similar ALI rates compared to those without a DPC (28.8% vs 29.4%, p=NS). Overall mortality with VA-ECMO cannulation was 55% over the study period, while 53% of patients with ALI did not survive to 30 days post-decannulation.
Conclusion: This study is one of the largest retrospective cohort studies examining efficacy of DPC in reducing the incidence of ALI. Patients receiving DPCs were found to have a similar incidence of ALI. Development of ALI was not significantly associated with increased mortality. Methods to continuouly assess distal blood flow are needed even in the presence of DPCs. Establishemnt of selection criteria for the use of DPCs may improve outcomes.