PMID- 32996725
OWN - NLM
STAT- MEDLINE
DCOM- 20210830
LR  - 20210830
IS  - 1827-1839 (Electronic)
IS  - 0392-9590 (Linking)
VI  - 40
IP  - 1
DP  - 2021 Feb
TI  - Distal perfusion cannulae reduce extracorporeal membrane oxygenation-related limb 
      ischemia.
PG  - 77-82
LID - 10.23736/S0392-9590.20.04408-9 [doi]
AB  - BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a 
      means of providing cardiopulmonary support that is being increasingly used in 
      patients with acute heart failure. When ECMO cannulae are placed peripherally, 
      their large diameters pose a risk of limb ischemia. Distal perfusion cannulae 
      (DPC) have been proposed as means to reduce risk, but their use is not 
      recommended by the most recent ECMO guidelines. We sought to establish their 
      utility at our institution. METHODS: We performed a retrospective review of of 
      all patients treated with peripheral VA-ECMO at our institution from 2013-2018. 
      During the first 2 years, DPC were not routinely placed, whereas in the final 4 
      years, DPC were recommended as part of the ECMO cannulation routine. RESULTS: One 
      hundred and one patients were treated with peripheral VA-ECMO, with an overall 
      mortality of 61%. By univariate analysis, obesity (47% vs. 75%, P<0.01) and limb 
      ischemia (57% vs. 83%, P<0.05) were associated with increased mortality. DPC were 
      placed prophylactically in 49% of patients. Prophylactic placement of a DPC at 
      the time of cannulation significantly reduced the incidence of limb ischemia (2% 
      vs. 32%, P<0.05), but did not impact mortality (53% vs. 69%, P=0.0953). In 
      patients who did not have a DPC placed during ECMO cannulation and subsequently 
      developed limb ischemia, late DPC placement for limb salvage did not impact 
      mortality. CONCLUSIONS: Limb ischemia portends a poor outcome in VA-ECMO 
      patients, and prophylactic DPC placement significantly reduces the risk of limb 
      ischemia. We propose prophylactic DPC placement be considered in patients 
      requiring peripheral VA-ECMO.
FAU - Hanley, Stephen C
AU  - Hanley SC
AD  - Division of Vascular Surgery, Tufts Medical Center, Boston, MA, USA.
FAU - Melikian, Raffi
AU  - Melikian R
AD  - Division of Vascular Surgery, Tufts Medical Center, Boston, MA, USA.
FAU - Mackey, William C
AU  - Mackey WC
AD  - Division of Vascular Surgery, Tufts Medical Center, Boston, MA, USA.
FAU - Salehi, Payam
AU  - Salehi P
AD  - Division of Vascular Surgery, Tufts Medical Center, Boston, MA, USA.
FAU - Iafrati, Mark D
AU  - Iafrati MD
AD  - Division of Vascular Surgery, Tufts Medical Center, Boston, MA, USA.
FAU - Suarez, Luis
AU  - Suarez L
AD  - Division of Vascular Surgery, Tufts Medical Center, Boston, MA, USA - 
      lsuarez1@tuftsmedicalcenter.org.
LA  - eng
PT  - Journal Article
DEP - 20200930
PL  - Italy
TA  - Int Angiol
JT  - International angiology : a journal of the International Union of Angiology
JID - 8402693
SB  - IM
MH  - Cannula
MH  - *Catheterization, Peripheral
MH  - *Extracorporeal Membrane Oxygenation
MH  - Femoral Artery
MH  - Humans
MH  - *Ischemia/therapy
MH  - Perfusion
MH  - Retrospective Studies
MH  - Risk Factors
EDAT- 2020/10/01 06:00
MHDA- 2021/08/31 06:00
CRDT- 2020/09/30 08:57
PHST- 2020/10/01 06:00 [pubmed]
PHST- 2021/08/31 06:00 [medline]
PHST- 2020/09/30 08:57 [entrez]
AID - S0392-9590.20.04408-9 [pii]
AID - 10.23736/S0392-9590.20.04408-9 [doi]
PST - ppublish
SO  - Int Angiol. 2021 Feb;40(1):77-82. doi: 10.23736/S0392-9590.20.04408-9. Epub 2020 
      Sep 30.