PMID- 29485958
OWN - NLM
STAT- MEDLINE
DCOM- 20180723
LR  - 20181023
IS  - 1522-6662 (Electronic)
IS  - 1098-3511 (Linking)
VI  - 21
IP  - 1
DP  - 2018 Jan 16
TI  - Identifying the Risk Factor and Prevention of Limb Ischemia in Extracorporeal 
      Membrane Oxygenation with Femoral Artery Cannulation.
PG  - E018-E022
LID - 10.1532/hsf.1824 [doi]
AB  - OBJECTIVE: Application of extracorporeal membrane oxygenation (ECMO) for life 
      support has been widely used in various fields of resuscitation. When the common 
      femoral artery (CFA) is used during cannulation for ECMO support in adults, it is 
      often complicated by limb ischemia. Placement of distal perfusion catheter (DPC) 
      can reduce the incidence of limb ischemia and increases the likelihood of limb 
      preservation, but selection criteria is uncertain. METHODS: This is a 
      retrospective study. Data was reviewed for patients in one medical center who 
      were supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO) via 
      CFA cannulation percutaneously between January 2008 and June 2014. Two groups 
      were divided into no-ischemia and ischemic limb. Age, sex, height, weight, body 
      surface area (BSA), cannula size, femoral artery diameter, comorbidity, acute 
      physiology and chronic health evaluation (APACHE) II score, vasoactive-inotropic 
      score (VIS) and mortality rate were analyzed. Doppler was used by measuring the 
      distal pulsation in the dorsalis pedis and posterior tibial artery to select the 
      patients. A DPC was prophylactically inserted percutaneously into the superficial 
      femoral artery for antegrade flow to the extremity in the patients who met 
      selection criteria. RESULTS: 139 (43.6%) patients were included in the study and 
      limb ischemia occurred in 46 (33%) of 139. There was a significant difference 
      between the no-ischemia group and the ischemia group in age (55.5 +/- 14.2 versus 
      63.2 +/- 13.2; P < .001), common femoral artery diameter (0.82 +/- 0.14 versus 0.63 +/- 
      0.17; P < .001 ), known peripheral artery occlusive disease (9% versus 24%; P < 
      .001) and VIS (12.1 +/- 8.1 versus 15.8 +/- 10.1; P < .001). Mortality rate was 
      higher in the ischemia group (46% versus 26% ; P < .001). 11 patients who met the 
      selection criteria had a DPC prophylactically inserted and no ischemia limb 
      occurred. CONCLUSION: Smaller common femoral artery diameter (</=6.3 cm); known 
      peripheral arterial occlusive disease; higher VIS (>/=15.8); absence of distal 
      pulsation pre-cannulation or immediately after post-cannulation or 4 hrs later 
      have higher risk of limb ischemia when CFA cannulation is used for VA-ECMO. Due 
      to this, the mortality and morbidity rate increases when limb ischemia occurs. A 
      DPC should be prophylactically inserted in high-risk patients who meet selection 
      criteria.
FAU - Yen, Chih-Chien
AU  - Yen CC
AD  - Division of Cardiovascular Surgery, Department of Surgery, Taoyuan Armed Forces 
      General Hospital, Taoyuan, Taiwan.
AD  - Taipei Medical University Graduate Institute of Injury Prevention and Control, 
      Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
FAU - Kao, Chih-Hong
AU  - Kao CH
AD  - Division of Cardiovascular Surgery, Department of Surgery, Taoyuan Armed Forces 
      General Hospital, Taoyuan, Taiwan.
FAU - Tsai, Chien-Sung
AU  - Tsai CS
AD  - Division of Cardiovascular Surgery, Department of Surgery, Taoyuan Armed Forces 
      General Hospital, Taoyuan, Taiwan.
AD  - Department of Cardiovascular Surgery, Tri-Service General Hospital, National 
      Defense Medical Center, Taipei, Taiwan
FAU - Tsai, Shin-Han
AU  - Tsai SH
AD  - Taipei Medical University Graduate Institute of Injury Prevention and Control, 
      Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
LA  - eng
PT  - Journal Article
DEP - 20180116
PL  - United States
TA  - Heart Surg Forum
JT  - The heart surgery forum
JID - 100891112
SB  - IM
MH  - Extracorporeal Membrane Oxygenation/*adverse effects
MH  - Extremities/*blood supply
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Ischemia/epidemiology/etiology/*prevention & control
MH  - Male
MH  - Middle Aged
MH  - Peripheral Vascular Diseases/epidemiology/etiology/*prevention & control
MH  - *Postoperative Complications
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
MH  - Risk Factors
MH  - Taiwan/epidemiology
OTO - NOTNLM
OT  - Distal perfusion catheter (DPC)
OT  - Extracorporeal membrane oxygenation (ECMO)
OT  - Limb ischemia
EDAT- 2018/02/28 06:00
MHDA- 2018/07/24 06:00
CRDT- 2018/02/28 06:00
PHST- 2017/04/22 00:00 [received]
PHST- 2017/07/07 00:00 [accepted]
PHST- 2018/02/28 06:00 [entrez]
PHST- 2018/02/28 06:00 [pubmed]
PHST- 2018/07/24 06:00 [medline]
AID - 10.1532/hsf.1824 [doi]
PST - epublish
SO  - Heart Surg Forum. 2018 Jan 16;21(1):E018-E022. doi: 10.1532/hsf.1824.