Arterial Vascular Complications in Peripheral Extracorporeal Membrane Oxygenation Support: A Review of Techniques and Outcomes

Abstract

Peripheral venoarterial extracorporeal membrane oxygenation support provides prolonged support in the event of acute or acute-on-chronic cardiac and/or respiratory failure. This support serves as a bridge to recovery, decision-making, heart transplantation or ventricular-assist device implantation. It can be implanted either through a percutaneous approach using Seldinger's technique or via an open approach via the common femoral artery or the axillary artery. Early and late arterial vascular complications remain an important issue, with rates of up to 28% with femoral and axillary cannulation sites. Among them, limb ischemia requires prompt diagnosis and management to avoid limb amputation. In the case of peripheral artery cannulation, ipsilateral distal limb perfusion to prevent acute limb ischemia can be performed via a single lumen catheter through the artery or via the 'chimney graft' technique during extracorporeal membrane oxygenation implantation.

Successful Treatment of Severe Carbon Monoxide Poisoning and Refractory Shock Using Extracorporeal Membrane Oxygenation

“…In comparison, axillary artery cannulation results in antegrade aortic flow and is preferred for patients with preserved left-ventricular function. 15 Compared with femoral percutaneous cannulation, the axillary approach usually requires surgical dissection and is more time-consuming. In our patient, femoral artery access was chosen due to severe hemodynamic instability and need for rapid deployment of ECMO.…”

Isn’t Limb as Precious as Life?

“…Whereas, a recent metanalysis reviewing 20 studies comprising 1886 patients revealed a pooled estimate of rate of limb ischemia as high as 16.9% (12.5-22.6%); compartment syndrome at 10.3% (7.3-14.5%) and amputation at 4.7% (2.3-9.3%) [13]. Other contemporary, smaller reviews report limb ischemia in range of 4.4-19% and 11-52% [14,15]. The variation among published literature in incidence of limb ischemia and related complications may be due to difference in inclusion criteria of patients, difference in definition of limb ischemia and publication bias.…”

Novel Uses of Extracorporeal Membrane Oxygenation in Adults

“…52 Because ECMO for PH traditionally requires a venoarterial configuration to bypass the pulmonary vascular bed, such support may be associated with the complications of femoral arterial cannulation. 53,54 The development of several novel upper-body configuration strategies minimizes these risks and facilitates mobilization. Internal jugular venous drainage may be combined with subclavian arterial reinfusion via an end-to-side graft.…”