Acute vascular complications of femoral venoarterial ECMO; a single center retrospective study

• Published in: European heart journal. Acute cardiovascular care Vol. 10; no. Supplement_1
• Main Authors: Laimoud, M, Saad, E, Koussayer, S
• Format: Journal Article
• Language: English
• Published: 26.04.2021
• ISSN: 2048-8726; 2048-8734
• DOI: 10.1093/ehjacc/zuab020.150

Abstract Funding Acknowledgements Type of funding sources: None. Backgroud Emergent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to provide rapid cardiopulmonary resuscitation in adult patients with refractory cardiogenic shock . Femoral arterial cannulation may result in  ipsilateral limb ischemia due to  reduced distal  blood flow below the insertion point of the cannula .We retrospectively studied  adult patients supported with femoral VA-ECMO for cardiogenic shock between  2015 and 2019 at our tertiary care hospital.  Results : the study included 65 adult patients supported on femoral VA-ECMO  for refractory cardiogenic shock . The studied patients had  a mean age of 37.9 ± 14.87 years , mostly males (70.8%) , a mean  BSA of 1.77 ±0.27 m2 and a mean BMI of 26.1 ± 6.7 kg/m2 . Twenty one (32.3%) patients developed acute lower limb ischemia. Femoral thrombectomy and angioplasty were done in 20 (30.8% ) patients . Four  (6.2%) patients developed limb compartmental syndrome and fasciotomy was done . Amputation of toes was done in one patient . The vascular complications included cannulation site bleeding in 24.6% of patients ,  femoral arteriovenous fistula in one patient and  large pseudoaneurysm after ECMO decannulation and required vascular surgical repair . Three (4.6%) patients developed chronic limb ischemia manifestations after hospital discharge . The patients who developed acute  limb ischemia had significantly frequent AKI (<0.001) without significant use of haemodialysis (p = 0.07) and longer ICU stay (p = 0.028) compared to the patients without limb ischemia. The hospital mortality occurred in 29 (44.6%)  patients  without significant difference between the patients with and without acute limb ischemia.  The  occurrence of acute  limb ischemia was significantly  correlated with failed percutaneous femoral cannulation (p = 0.039 )  while there was no significant statistical correlation between the  cut-down technique and occurrence of limb ischemia(p = 0.053).  The occurrence of femoral cannulation site bleeding was significantly correlated with failed percutaneous cannulation (p = 0.001 ) and cut-down technique (p = 0.001) .  Conclusion :  Acute vascular complications are frequent after femoral VA-ECMO. Failed percutaneous femoral cannulation has been, in this study identified as the most important risk factor for acute limb ischemia and cannulation site bleeding. Recommendation: A careful approach during femoral cannulation is recommended to prevent occurrence of acute limb ischemia and femoral cannulation site bleeding. Abstract Figure. Cannulation approaches of VA-ECMO .