Risk factors for severe lower extremity ischemia following venoarterial extracorporeal membrane oxygenation: an analysis using a nationwide inpatient database

• Published in: Trauma surgery & acute care open 2022-04, Vol.7 (1), p.e000776-e000776
• Main Authors: Honda, Akira, Michihata, Nobuaki, Iizuka, Yoichi, Uda, Kazuaki, Morita, Kojiro, Mieda, Tokue, Takasawa, Eiji, Ishiwata, Sho, Tajika, Tsuyoshi, Matsui, Hiroki, Fushimi, Kiyohide, Yasunaga, Hideo, Chikuda, Hirotaka
• Format: Article
• Language: English
• Subjects: Age; Amputation; Anticoagulants; Body mass index; Cerebrovascular disease; Coma; Comorbidity; Compartment syndrome; Consciousness; Diabetes; Extracorporeal membrane oxygenation; Gangrene; Hospitals; Injuries; Ischemia; Lifesaving; Lung diseases; Original Research; Overweight; Patients; Pneumonia; Risk factors
• ISSN: 2397-5776; 2397-5776
• DOI: 10.1136/tsaco-2021-000776

ObjectivesVenoarterial extracorporeal membrane oxygenation is increasingly being used as a life-saving modality in critically ill patients. Despite its necessity, severe lower extremity ischemia associated with venoarterial extracorporeal membrane oxygenation remains a potentially devastating complication. We aimed to investigate the incidence and risk factors for severe lower extremity ischemia requiring fasciotomy or amputation following venoarterial extracorporeal membrane oxygenation.MethodsAll patients who received venoarterial extracorporeal membrane oxygenation during hospitalization were identified in a Japanese national inpatient database from July 1, 2010 to March 31, 2018. The primary outcome was occurrence of severe lower extremity ischemia that required fasciotomy or amputation. We used cause-specific proportional hazard models to examine the associations between potential risk factors and outcomes. We also performed a competing-risk analysis to estimate the cause-specific HR for severe lower extremity ischemia using a multivariable competing-risk Cox proportional hazard model with adjustment for potential risk factors.ResultsA total of 29 231 patients who underwent venoarterial extracorporeal membrane oxygenation during hospitalization were identified. Of these, 98 patients (0.3%) had lower extremity ischemia requiring fasciotomy or amputation. The young group (≤18 years) had a significantly higher proportion of severe lower extremity ischemia cases than the adult (19–59 years) and elderly (≥60 years) groups (1.4%, 0.5%, and 0.2%, respectively; p