The Preventive Effect of Distal Perfusion Catheters on Vascular Complications in Patients Undergoing Venous Artery Extracorporeal Membrane Oxygenation

Abstract

Objective To investigate the preventive effect of distal perfusion catheters (DPCs) on vascular complications in patients undergoing venous artery extracorporeal membrane oxygenation (VA-ECMO). Methods Patients who underwent VA-ECMO through a femoral approach in our hospital were included in this study, and they were divided into two groups according to their use of DPC. Clinical indicators were compared between the two groups, including the ECMO running time, intensive care unit (ICU) time, length of hospital stay, ECMO auxiliary results, the incidence of limb ischemia and vascular complications. Results In total, 250 patients were included in this study, including the DPC group (age: 48 [32–62] years old, 58.4% male, n = 125) and the non-DPC group (age: 51 [36–63] years old, 65.6% male, n = 125). The DPC group was less likely to have limb complications than the non-DPC group (6.4% vs 17.6%, P = 0.006), mainly resulting from distal ischemia (4.0% vs 15.2%, P = 0.003) and necrosis (1.6% vs 9.6%, P = 0.006). The ECMO duration had a median of 92.3 (75.7–109) h in the DPC group and 71.2 (59.4–82.8) h in the DPC group, with a difference close to the statistical threshold ( P = 0.054). There was no significant difference in ICU time or length of hospital stay between the two groups. The multivariate analysis showed that the DPC implantation was negatively associated with limb complications (odds ratio: 0.265, 95% confidence interval: 0.107–0.657, P = 0.004) after adjustment for confounding factors. Conclusion Distal perfusion catheter placement might be associated with a decreased risk of vascular complications and limb ischemia in patients undergoing femoral VA-ECMO cannulation. Further randomised studies are still needed to verify its benefit on clinical outcomes.

One Limb or Two? Does It Make a Difference in Femoral Venoarterial Extracorporeal Membrane Oxygenation?*

“…The concern for underreporting of cannulation issues to the ELSO registry has been commented on by others (6), who have noted incidence levels of 10-70%, compared with the 8.3% reported in the Simons et al ( 4) report. The low recorded use of distal perfusion cannulas is also intriguing, as many centers by anecdotal and prior reports, use this routinely as a preventive measure to avoid distal arterial limb ischemia, especially when providing surgical arterial cannulation (7,8). There is no detail on cannula size in the current report, which is a major limitation that is also commented on by the authors.…”