27 Lower limb ischaemia in patients undergoing VA ECMO

The incidence of lower limb ischaemia ranges from 11%–52% in patients receiving VA ECMO. The reported rate of amputation ranges from 2%–10%. Patients with vascular complications related to lower limb ischaemia carries a higher risk of death. Antegrade perfusion of superficial femoral artery via a distal perfusion catheter (DPC) has been shown to be an effective therapy to reduce the incidence of lower limb ischaemia. However, the clinical indications remain largely unclear with various reported strategies. While the benefits remain largely unknown, there is increasing experience on the use of near-infrared reflectance spectroscopy, or NIRS, in the monitoring of lower limb perfusion during ECMO therapies. Strategies alternative to DPC include end-to-side graft, posterior tibial artery retrograde perfusion, axillary cannulation and central sports mode. Novel bidirectional perfusion cannula may appear as a future promising option. References Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, Esmailian F, Azarbal B. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg 2014;97:610–616. Tanaka D, Hirose H, Cavarocchi N, Entwistle JW. The impact of vascular complications on survival of patients on venoarterial extracorporeal membrane oxygenation. Ann Thorac Surg 2016;101:1729–1734. Juo YY, Skancke M, Sanaiha Y, Mantha A, Jimenez...
Source: Heart Asia - Category: Cardiology Authors: Tags: Keynote Lecture Source Type: research