Fluoroscopy-guided simultaneous distal perfusion as a preventive strategy of limb ischemia in patients undergoing extracorporeal membrane oxygenation

Background Limited data are available regarding prevention of limb ischemia in femorally cannulated patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). We investigated the association between strategy of distal perfusion catheter (DPC) insertion and vascular complications like li...

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Published in:Annals of intensive care 2018-10, Vol.8 (1), p.101-8, Article 101
Main Authors: Jang, Woo Jin, Cho, Yang Hyun, Park, Taek Kyu, Song, Young Bin, Choi, Jin-Oh, Hahn, Joo-Yong, Choi, Seung-Hyuk, Gwon, Hyeon-Cheol, Jeon, Eun-Seok, Chun, Woo Jung, Oh, Ju Hyeon, Yang, Jeong Hoon
Format: Article
Language:English
Subjects:
Anesthesiology
Catheters
Critical Care Medicine
Distal perfusion catheter
Emergency Medicine
Extracorporeal membrane oxygenation
Intensive
Intensive care
Ischemia
Legs
Limb ischemia
Medical imaging
Medicine
Medicine & Public Health
Oxygen therapy
Quantitative analysis
Respiratory therapy
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Summary:Background Limited data are available regarding prevention of limb ischemia in femorally cannulated patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). We investigated the association between strategy of distal perfusion catheter (DPC) insertion and vascular complications like limb ischemia in patients undergoing VA-ECMO. Methods We evaluated 230 patients from two tertiary hospitals who received VA-ECMO via femoral cannulation between August 2014 and July 2017. The patients were divided into two groups according to DPC insertion strategy: patients who underwent DPC insertion at the time of primary cannulation (DPC group, n  = 96) and patients who were provisionally treated with DPC (No-DPC group, n  = 134). The primary outcome was limb ischemia. Results Of the 96 patients in the DPC group, 61 (63.5%) underwent insertion under fluoroscopic guidance. The DPC group had a significantly lower incidence of limb ischemia (2.1% vs. 8.2%, p  = 0.047) and a lower tendency of in-hospital mortality (38.5% vs. 50.7%, p  = 0.067) than the No-DPC group. In the multivariable analysis, fluoroscopy-guided simultaneous insertion of the DPC (odds ratio 0.11; 95% confidence interval 0.01–0.98; p  = 0.048) was a significant predictor of reduction of limb ischemia. Conclusions Simultaneous insertion of a DPC, particularly under fluoroscopy guidance, can be considered as a preventive strategy for limb ischemia in femorally cannulated patients on VA-ECMO.
ISSN:2110-5820
2110-5820
DOI:10.1186/s13613-018-0445-z