PMID- 33765883
OWN - NLM
STAT- MEDLINE
DCOM- 20220621
LR  - 20220629
IS  - 1477-111X (Electronic)
IS  - 0267-6591 (Linking)
VI  - 37
IP  - 5
DP  - 2022 Jul
TI  - Alternative option for limb reperfusion cannula placement for percutaneous 
      femoral veno-arterial ECMO.
PG  - 456-460
LID - 10.1177/02676591211003282 [doi]
AB  - Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is an established 
      last line support for severe, acute cardiorespiratory failure. In the case of VA 
      ECMO, peripheral cannulation via the femoral vessels is often advantageous when 
      compared with the alternative central cannulation, and is associated with better 
      clinical outcomes. One of the specific potential complications of peripheral 
      femoral arterial cannulation for ECMO, however, is ipsilateral distal lower limb 
      ischemia; a consideration especially when cannulating the vessel directly, as 
      distal limb perfusion is invariably compromised by an occlusive effect of the 
      arterial cannula within the femoral artery. The gold standard technique for lower 
      limb reperfusion is a separate size 6-7 Fr cannula inserted proximally into the 
      femoral artery, just below the insertion point of the ECMO return cannula, and 
      connected directly to the ECMO circuit so that the blood flow is also directed 
      distally to perfuse the entire limb. This functions well whether the ECMO cannula 
      has been placed percutaneously or by surgical cut-down. Although proximal femoral 
      arterial placement of the reperfusion cannula is the established and preferred 
      technique, there are many technical challenges which may preclude its placement. 
      Local haematoma or bleeding post ECMO insertion, peripheral vascular disease, 
      constricted vasculature in severely shocked patients, or patient obesity are all 
      common reasons why placement of the proximal reperfusion cannula may be 
      difficult, or impossible. In such instances, our retrograde perfusion technique 
      may maintain limb perfusion and may even be limb saving for patients on VA ECMO 
      support.
FAU - Gobolos, Laszlo
AU  - Gobolos L
AUID- ORCID: 0000-0001-7584-6025
AD  - Department of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic Abu 
      Dhabi, Abu Dhabi, United Arab Emirates.
FAU - Hogan, Maurice
AU  - Hogan M
AD  - Departments of Cardiac Anesthesia and Intensive Care, Cleveland Clinic Abu Dhabi, 
      Abu Dhabi, United Arab Emirates.
FAU - Kakar, Vivek
AU  - Kakar V
AD  - Departments of Cardiac Anesthesia and Intensive Care, Cleveland Clinic Abu Dhabi, 
      Abu Dhabi, United Arab Emirates.
FAU - Raposo, Nuno
AU  - Raposo N
AD  - Department of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic Abu 
      Dhabi, Abu Dhabi, United Arab Emirates.
FAU - Sanger, Stefan
AU  - Sanger S
AD  - Department of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic Abu 
      Dhabi, Abu Dhabi, United Arab Emirates.
FAU - Bhatnagar, Gopal
AU  - Bhatnagar G
AD  - Department of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic Abu 
      Dhabi, Abu Dhabi, United Arab Emirates.
FAU - Park, Woosup Michael
AU  - Park WM
AD  - Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic 
      Abu Dhabi, Abu Dhabi, United Arab Emirates.
LA  - eng
PT  - Journal Article
DEP - 20210326
PL  - England
TA  - Perfusion
JT  - Perfusion
JID - 8700166
SB  - IM
CIN - Perfusion. 2022 Jul;37(5):437-438. PMID: 35534237
MH  - Cannula/adverse effects
MH  - *Catheterization, Peripheral/adverse effects
MH  - *Extracorporeal Membrane Oxygenation/methods
MH  - Femoral Artery/surgery
MH  - Humans
MH  - Ischemia
MH  - Lower Extremity/blood supply
MH  - Reperfusion/adverse effects
MH  - Retrospective Studies
MH  - Risk Factors
OTO - NOTNLM
OT  - ECMO
OT  - dorsalis pedis artery
OT  - limb ischemia
OT  - peripheral cannulation
OT  - retrograde perfusion
EDAT- 2021/03/27 06:00
MHDA- 2022/06/22 06:00
CRDT- 2021/03/26 05:36
PHST- 2021/03/27 06:00 [pubmed]
PHST- 2022/06/22 06:00 [medline]
PHST- 2021/03/26 05:36 [entrez]
AID - 10.1177/02676591211003282 [doi]
PST - ppublish
SO  - Perfusion. 2022 Jul;37(5):456-460. doi: 10.1177/02676591211003282. Epub 2021 Mar 
      26.