Short stature is associated with the development of lower limb ischaemia during extracorporeal life support

Park, Byoung-Won; Lee, So‐Ryoung; Bang, Duk Won; Hyon, Min-Su; Chang, Won-Ho; Oh, Hong Chul; Park, Young Woo; Park, Suyeon

doi:10.1177/0267659118755273

Cited by 9 publications

(9 citation statements)

References 17 publications

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“…Three studies dealt with limb ischemia in the ECPR setting: pooling data from these studies on 253 patients, 27 episodes of limb ischemia (10.6%) were detected, though it should be highlighted that in the study by Voicu et al the mortality was high, and the absence of peripheral complications may be likely related to the marked early mortality [25, 27, 41].…”

Section: Narrative Reviewmentioning

confidence: 99%

“…Two studies distinctly considered the concomitant use of V-A ECMO and intra-aortic balloon pump (IABP), describing limb complications. Pooling the data, on 55 patients, we found 4 episodes of limb ischemia (7.2%), with an even protective role for the IABP placement in this setting [25, 31].…”

Section: Narrative Reviewmentioning

confidence: 99%

“…The principal mechanism is a reduced blood flow and related oxygen supply, which arises from an absolute or relative deficit of arterial blood flow to distal tissues. It may be due to a nearly occluding arterial cannula, selective perfusion of the arteria femoralis profunda , femoral or iliac vessel damage during cannulation, inadequate peripheral perfusion to match tissue demand, high level of vasopressors, an extrinsic compression of the distal arterial vessel by the same arterial or venous cannula, or atherosclerotic arterial disease, especially in the absence of collateral circulation [14, 15, 19, 25, 54]. Indeed, larger cannulas (> 20 Fr), female gender, younger age, and the presence of peripheral vascular disease are the main risk factors.…”

Section: Narrative Reviewmentioning

confidence: 99%

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Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment

et al. 2019

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Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is an increasingly adopted life-saving mechanical circulatory support for a number of potentially reversible or treatable cardiac diseases. It is also started as a bridge-to-transplantation/ventricular assist device in the case of unrecoverable cardiac or cardio-respiratory illness. In recent years, principally for non-post-cardiotomy shock, peripheral cannulation using the femoral vessels has been the approach of choice because it does not need the chest opening, can be quickly established, can be applied percutaneously, and is less likely to cause bleeding and infections than central cannulation. Peripheral ECMO, however, is characterized by a higher rate of vascular complications. The mechanisms of such adverse events are often multifactorial, including suboptimal arterial perfusion and hemodynamic instability due to the underlying disease, peripheral vascular disease, and placement of cannulas that nearly occlude the vessel. The effect of femoral artery damage and/or significant reduced limb perfusion can be devastating because limb ischemia can lead to compartment syndrome, requiring fasciotomy and, occasionally, even limb amputation, thereby negatively impacting hospital stay, long-term functional outcomes, and survival. Data on this topic are highly fragmentary, and there are no clear-cut recommendations. Accordingly, the strategies adopted to cope with this complication vary a great deal, ranging from preventive placement of antegrade distal perfusion cannulas to rescue interventions and vascular surgery after the complication has manifested. This review aims to provide a comprehensive overview of limb ischemia during femoral cannulation for VA-ECMO in adults, focusing on incidence, tools for early diagnosis, risk factors, and preventive and treating strategies.

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Section: Narrative Reviewmentioning

confidence: 99%

Section: Narrative Reviewmentioning

confidence: 99%

Section: Narrative Reviewmentioning

confidence: 99%

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Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment

et al. 2019

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“…These complications are more frequent with peripheral arterial cannulation due to the small vessel size. Peripheral arterial cannulation can also be associated with limb ischemia, particularly in patients that have a short stature (76). The size of the artery should be estimated by ultrasound if possible, and a suitable cannula size should be chosen.…”

Section: Complications Of Eclsmentioning

confidence: 99%

Principles and indications of extracorporeal life support in general thoracic surgery

McRae¹,

Perrot²

2018

J. Thorac. Dis.

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The role of extracorporeal life support (ECLS) has expanded rapidly over the past 15 years to become an important tool in advanced general thoracic surgery practice. Intra-operative and in some cases continued post-operative ECLS is redefining the scope of complex surgical care. ECLS encompasses a spectrum of temporary mechanical support that may remove CO 2 , oxygenate or provide hemodynamic support or a combination thereof. The most common modalities used in general thoracic surgery include extracorporeal membrane oxygenation (ECMO), interventional lung assist device (iLA ® Novalung ® , Heilbronn, Germany), and extracorporeal CO 2 removal (ECCO 2 R). The ECMO and Novalung ® devices can be used in different modes for the short term or long-term support depending on the situation. In this review, the principles and current applications of ECLS in general thoracic surgery are presented.

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“…[1][2][3][4][5][6] Severe limb ischemia may necessitate surgical interventions, such as fasciotomy or revascularization, and even lead to limb loss, or contribute to patient death. 4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Consequently, monitoring and optimization of distal limb perfusion during V-A ECLS is pivotal to prevent sever shortcoming and, most likely, even improve outcomes. 4 In the last decades, several techniques to provide distal limb perfusion and limit or prevent the risk for limb ischemia-related complications have been developed.…”

Section: Introductionmentioning

confidence: 99%

Novel cannulation strategy with a bidirectional cannula for distal limb perfusion during peripheral veno-arterial extracorporeal life support: A preliminary, single-centre study

et al. 2023

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Introduction Limb ischemia is a severe complication of peripheral veno-arterial extracorporeal life support (V-A ECLS). Several techniques have been developed to prevent this, but it remains a major and frequent adverse event (incidence: 10–30%). In 2019, a new cannula with bidirectional flow (retrograde towards the heart and antegrade towards the distal limb) has been introduced. A single-centre experience with this cannula in patients undergoing peripheral V-A ECLS is herewith reported. Methods This prospective observational study included adults (≥18 years) undergoing V-A ECLS from January 2021 to October 2022 with the use of a bidirectional femoral artery cannula. Primary outcome was limb ischemia requiring intervention during cardio-circulatory support. Secondary outcomes were compartment syndrome, limb amputation, cannulation site bleeding, need for other surgical intervention due to cannula related complications, duplex ultrasound parameters from the femoral vessels, and in-hospital survival. Results Twenty-two consecutive patients were included. During extracorporeal life support (ECLS) support, limb ischemia requiring intervention occurred in one patient (4.5%) and no patients developed a compartment syndrome, or required a fasciotomy or amputation. Significant bleeding was reported in two patients (9%) due to slight cannula dislodgement, easily solved with cannula repositioning. In-hospital survival was 63.6%. Conclusions The bidirectional cannula is associated with a low risk for limb ischemia-related complications compared to current literature, and apparently represents a safe alternative to dedicated distal perfusion cannula. Further studies are warranted to confirm these preliminary findings.

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Short stature is associated with the development of lower limb ischaemia during extracorporeal life support

Abstract: Smaller female patients are more prone to developing limb ischaemia from femoral ECLS. Our findings might support preventative distal perfusion and more careful observation of these patients.

Cited by 9 publications

References 17 publications

Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment

Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment

Principles and indications of extracorporeal life support in general thoracic surgery

Novel cannulation strategy with a bidirectional cannula for distal limb perfusion during peripheral veno-arterial extracorporeal life support: A preliminary, single-centre study

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