scholarly journals Percutaneous distal perfusion of the lower extremity after femoral cannulation for venoarterial extracorporeal membrane oxygenation in a small child

2009 ◽  
Vol 44 (2) ◽  
pp. 437-440 ◽  
Author(s):  
Mary Jo Haley ◽  
Jason C. Fisher ◽  
Alejandro R. Ruiz-Elizalde ◽  
Charles J.H. Stolar ◽  
Nicholas J. Morrissey ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Extracorporeal Membrane Oxygenation ◽  
Small Child ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Distal Perfusion

Venoarterial Extracorporeal Membrane Oxygenation via Direct Axillary Artery Cannulation

2021 ◽  
pp. 155698452110126
Author(s):  
Aakash Shah ◽  
Ronson J. Madathil ◽  
Bartley P. Griffith ◽  
David J. Kaczorowski
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Axillary Artery ◽  
Effective Means ◽  
Severe Pulmonary Hypertension ◽  
Artery Cannulation ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Femoral Vessels ◽  
Distal Perfusion ◽  
Va Ecmo

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an effective means of support for patients awaiting cardiac or cardiopulmonary transplantation. Typically, peripheral cannulation via the femoral vessels is preferred. However, an alternative is use of the axillary or subclavian artery, which is typically performed via a graft. Here we present the case of a patient who required VA-ECMO for cardiogenic shock with severe pulmonary hypertension as a bridge to heart-lung transplantation. Initially cannulated via the femoral artery, he was converted to a direct axillary cannulation strategy with a distal perfusion catheter and successfully bridged to transplantation. This technique avoids the use of an interposition graft and mitigates problems associated with it.

Aggressive placement of distal limb perfusion catheter in venoarterial extracorporeal membrane oxygenation

2020 ◽  
Vol 43 (12) ◽  
pp. 796-802 ◽  
Author(s):  
Suguru Ohira ◽  
Masashi Kawamura ◽  
Kristin Ahern ◽  
Nicholas Cavarocchi ◽  
Hitoshi Hirose
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Lower Limb ◽  
Early Period ◽  
Limb Ischemia ◽  
Late Period ◽  
Distal Limb ◽  
Lower Limb Ischemia ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Distal Perfusion

Objective: The aim of this study is to review the impacts of aggressive placement of a distal perfusion catheter on the outcomes in patients supported with venoarterial extracorporeal membrane oxygenation via femoral cannulation. Methods: Analysis was performed with 143 consecutive femoral venoarterial extracorporeal membrane oxygenation cannulation. Patients were divided into two groups: the early period (October 2010 to December 2012, N = 47) where placement of a distal perfusion catheter was attempted percutaneously but not surgically and the late period (January 2013 to November 2018, N = 96) in which placement of distal perfusion catheter was aggressively utilized both percutaneously and surgically. The modification of venoarterial extracorporeal membrane oxygenation cannulation protocol for the late period involved (1) an immediate insertion of a distal perfusion catheter regardless of the size of femoral arterial cannula, (2) an open insertion of a distal perfusion catheter if percutaneous approach failed, and (3) when venoarterial extracorporeal membrane oxygenation cannulation was completed at a non-extracorporeal membrane oxygenation cannulation center, it was encouraged that they attempt insertion of a distal perfusion catheter at the time of cannulation. Results: In the late period, a distal perfusion catheter was placed in 96% (92/96) which was significantly increased from 66% (31/47) in the early period. Of these 92 patients in late period, nine patients (9.8%) required open direct insertion of a distal perfusion catheter. The incidence of lower limb ischemia (early vs. late period 26% vs 12%, P = 0.031) was significantly decreased in the late period. Logistic regression analyses showed that distal perfusion catheter placement was the only factor for preventing lower limb ischemia. Conclusion: Aggressive insertion of a distal perfusion catheter even utilizing surgical cut-down technique was shown to decrease the incidence of distal limb complications.

Bedside angiography of distal perfusion catheter for veno-arterial extracorporeal membrane oxygenation

Perfusion ◽  
2021 ◽  
pp. 026765912110070
Author(s):  
Aakash Shah ◽  
Danielle Arons ◽  
Chetan Pasrija ◽  
Zachary N Kon ◽  
Mehrdad Ghoreishi
Keyword(s):  
Lower Extremity ◽  
Extracorporeal Membrane Oxygenation ◽  
Retrospective Analysis ◽  
Saphenous Vein ◽  
Single Center ◽  
Membrane Oxygenation ◽  
Distal Perfusion ◽  
Va Ecmo

Background: The aim of this study was to evaluate the ipsilateral lower extremity (ILE) outcomes of patients who underwent bedside angiography via the distal perfusion catheter while on femoral veno-arterial extracorporeal membrane oxygenation (VA ECMO). Methods: This is a retrospective analysis of all patients placed on VA ECMO at a single center from January 2017 to December 2019 who underwent bedside angiography via the distal perfusion catheter. Results: Twenty-four patients underwent bedside angiography via the distal perfusion catheter after being placed on VA ECMO. A vasodilator was directly administered in three patients for suspected spasm. One patient had distal thrombus and underwent thrombectomy and fasciotomy. One patient had a dislodged catheter and underwent thrombectomy, fasciotomy, and replacement of the catheter. One patient had severe ILE ischemia, however was not intervened upon due to critical acuity. Finally, one patient had inadvertent placement in the saphenous vein and had a new catheter placed in the SFA. No patients underwent amputation. Ultimately, 21 patients (87.5%) had no ILE compromise at the end their ECMO course. Survival to decannulation was 66.7% ( n = 16). Conclusions: Bedside angiography of the distal perfusion catheter is feasible and can be a useful adjunct in informing the need for further intervention to the ILE. Classifications: extracorporeal membrane oxygenation, ischemia

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