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

• Main Authors: Woo Jin Jang, Yang Hyun Cho, Taek Kyu Park, Young Bin Song, Jin-Oh Choi, Joo-Yong Hahn, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Eun-Seok Jeon, Woo Jung Chun, Ju Hyeon Oh, Jeong Hoon Yang
• Format: Article
• Language: English
• Published: SpringerOpen 2018-10-01
• Series: Annals of Intensive Care
• Subjects: Distal perfusion catheter; Limb ischemia; Extracorporeal membrane oxygenation
• Online Access: http://link.springer.com/article/10.1186/s13613-018-0445-z

Abstract 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.