R. Lyons1, D. Dexter1, R. Lyons1 1Eastern Virginia Medical School,Surgery,Norfolk, VA, USA
Introduction: Extracorporeal membrane oxygenation (ECMO) is an increasingly used modality in patients with complete cardiopulmonary collapse. The etiology of collapse varies from pulmonary embolism to cardiogenic shock post-cardiotomy. Two cannulation schemes exist for the placement of patients on ECMO, central and peripheral. One of the known complications of peripheral VA cannulation is distal limb ischemia. The objective of this study was to determine if antegrade perfusion of the ipsilateral limb leads to decreased limb ischemia in patients on peripheral VA ECMO.
Methods: A retrospective chart review of patients that underwent ECMO from 2014-2015 were included in the study. We examined patient demographics, medical comorbidities, cannula size, technique of cannulation (open Vs percutaneous), Average ACT, vasopressor use, development of ipsilateral limb ischemia, and overall outcome.
Results: We examined all patients that underwent ECMO during the study period. Of the 36 patients that underwent ECMO, 20 where cannulated peripherally and were eligible for the study. Of these, 4 developed limb ischemia. Three patients were cannulated via a chimney graft and one patient had an antegrade perfusion catheter. Three of these patients required fasciotomies for compartment syndrome and all patients that developed limb ischemia died. The strongest predictor of development of distal limb ischemia was the chimney end-to-side technique. Of the patients that underwent antegrade perfusion, only one of the 15 developed distal limb ischemia. Only one patient had percutaneous access without antegrade perfusion and they did not develop limb ischemia.
Conclusion: Various techniques exist for peripheral ECMO cannulation that include open and percutaneous, both of which have their own drawbacks. Although it is felt that an open end to side chimney technique would decrease the incidence of distal limb ischemia because there is no cannula present to block antegrade flow, we have found that at our institution it increased the risk of distal limb ischemia. We postulate that this may be due a steal phenomenom causing ipsilateral limb ischemia. In patients that underwent percutaneous access, distal perfusion of the ipsilateral limb was noted to be protective and should be utilized in all patients undergoing this form of access.
