scholarly journals Identifying the Risk Factor and Prevention of Limb Ischemia in Extracorporeal Membrane Oxygenation with Femoral Artery Cannulation

2018 ◽  
Vol 21 (1) ◽  
pp. 018 ◽  
Author(s):  
Chih-Chien Yen ◽  
Chih-Hong Kao ◽  
Chien-Sung Tsai ◽  
Shin-Han Tsai
Keyword(s):  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Femoral Artery ◽  
Selection Criteria ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Occlusive Disease ◽  
Membrane Oxygenation ◽  
Ischemia Group ◽  
Va Ecmo

Objective: Application of extracorporeal membrane oxygenation (ECMO) for life support has been widely used in various fields of resuscitation. When the common femoral artery (CFA) is used during cannulation for ECMO support in adults, it is often complicated by limb ischemia. Placement of distal perfusion catheter (DPC) can reduce the incidence of limb ischemia and increases the likelihood of limb preservation, but selection criteria is uncertain.Methods: This is a retrospective study. Data was reviewed for patients in one medical center who were supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO) via CFA cannulation percutaneously between January 2008 and June 2014. Two groups were divided into no-ischemia and ischemic limb. Age, sex, height, weight, body surface area (BSA), cannula size, femoral artery diameter, comorbidity, acute physiology and chronic health evaluation (APACHE) II score, vasoactive-inotropic score (VIS) and mortality rate were analyzed. Doppler was used by measuring the distal pulsation in the dorsalis pedis and posterior tibial artery to select the patients. A DPC was prophylactically inserted percutaneously into the superficial femoral artery for antegrade flow to the extremity in the patients who met selection criteria.Results: 139 (43.6%) patients were included in the study and limb ischemia occurred in 46 (33%) of 139. There was a significant difference between the no-ischemia group and the ischemia group in age (55.5 ± 14.2 versus 63.2 ± 13.2; P < .001), common femoral artery diameter (0.82 ± 0.14 versus 0.63 ± 0.17; P < .001 ), known peripheral artery occlusive disease (9% versus 24%; P < .001) and VIS (12.1 ± 8.1 versus 15.8 ± 10.1; P < .001). Mortality rate was higher in the ischemia group (46% versus 26% ; P < .001). 11 patients who met the selection criteria had a DPC prophylactically inserted and no ischemia limb occurred.Conclusion: Smaller common femoral artery diameter (≤6.3 cm); known peripheral arterial occlusive disease; higher VIS (≥15.8); absence of distal pulsation pre-cannulation or immediately after post-cannulation or 4 hrs later have higher risk of limb ischemia when CFA cannulation is used for VA-ECMO. Due to this, the mortality and morbidity rate increases when limb ischemia occurs. A DPC should be prophylactically inserted in high-risk patients who meet selection criteria.

A retrospective cohort analysis of percutaneous versus side-graft perfusion techniques for veno-arterial extracorporeal membrane oxygenation in patients with refractory cardiogenic shock

Perfusion ◽  
2016 ◽  
Vol 32 (5) ◽  
pp. 363-371 ◽  
Author(s):  
Mehmet Cakici ◽  
Evren Ozcinar ◽  
Cagdas Baran ◽  
Ahmet Onat Bermede ◽  
Mehmet Cahit Sarıcaoglu ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Femoral Artery ◽  
Vascular Complications ◽  
Ecmo Support ◽  
Acute Limb Ischemia ◽  
Membrane Oxygenation ◽  
Refractory Cardiogenic Shock ◽  
Cannulation Site ◽  
Va Ecmo

Objectives: This study was designed to compare vascular complications and the outcomes of ultrasound (US)-guided percutaneous cannulation with distal perfusion catheter (PC-DP) and arterial side-graft perfusion (SGP) techniques in patients who require veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for refractory cardiogenic shock (RCS). Methods: We conducted a retrospective, observational cohort study of consequtive patients with RCS treated with VA-ECMO at a single transplant center from March 2010 until August 2015. Overall, 148 patients underwent VA-ECMO for RCS (99 men, aged 56.6 ± 12.0 years; BSA, 1.85 ± 0.19). Patients were categorized based on VA-ECMO perfusion technique into PC-DP via femoral artery and SGP via axillary/femoral artery groups. Results: The median duration of VA-ECMO support was 5 days (range, 8 hours–80 days). Hospital mortality (PC-DP group, 54.7%; SGP group, 64.4%; p=0.23) and overall ECMO survival (PC-DP group, 36.9%; SGP group, 32.2%; p=0.47) was similar between the groups. There were no significant between-group differences in the rate of acute limb ischemia (PC-DP group, 4/75, 5.3%; SGP group, 2/73, 2.7%; p=0.68). However, the rate of surgical/cannulation site bleeding (PC-DP, 9/75 (12%) vs SGP, 18/73 (24.7%), p=0.05) and hyperperfusion syndrome (PC-DP, 2/75 (2.7%) vs SGP, 22/73 (30.1%),p=0.001) were higher in the SGP group than in the PC-DP group. Conclusions: We observed no significant difference in major vascular complications or survival between patients who underwent the PC-DP technique and those who underwent arterial SGP.

scholarly journals Double Distal Perfusion Catheters for Severe Limb Ischemia on the IABP Side in Patients Who Received Femoro-Femoral VA-ECMO With IABP

2021 ◽  
Vol 8 ◽  
Author(s):  
Meng Xin ◽  
Liangshan Wang ◽  
Xiaqiu Tian ◽  
Dengbang Hou ◽  
Hong Wang ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Near Infrared ◽  
Limb Ischemia ◽  
Symptomatic Treatment ◽  
Acute Limb Ischemia ◽  
Membrane Oxygenation ◽  
Number Of Patients ◽  
Distal Perfusion ◽  
Va Ecmo ◽  
Postcardiotomy Cardiogenic Shock

Background: Limited research is available on the pattern of double distal perfusion catheters in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) with an intra-aortic balloon pump(IABP). Here, we compared the outcomes of a double distal perfusion catheter and conventional treatment in patients who received VA-ECMO with IABP and had severe lower limb ischemia on the IABP side.Methods: We reviewed the data of 15 adult patients with postcardiotomy cardiogenic shock who received VA-ECMO via femoral cannulation combined with an IABP in the contralateral artery that was complicated with severe acute limb ischemia (ALI) on the same side as the IABP between January 2004 and December 2016. Patients underwent symptomatic treatment (conventional group, n = 9) and double distal perfusion catheterization treatment (DDPC group, n = 6). ALI was monitored using near-infrared spectroscopy placed on both calves after double distal perfusion catheters. The outcomes were compared.Results: All 6 patients who underwent double distal perfusion catheters were successfully decannulated without the development of osteofascial compartment syndrome, amputation, or bleeding and infection of the double distal perfusion catheters. The number of patients who weaned from extracorporeal membrane oxygenation successfully in the DDPC and conventional groups was 6 (100%) and 3 (33%, p = 0.028), respectively. The in-hospital mortality rates were 17% and 89% for the DDPC and conventional groups, respectively (p = 0.011).Conclusions: DDPC can be considered a strategy for severe limb ischemia on the IABP side in patients who received femoro-femoral VA-ECMO with IABP.

scholarly journals Extracorporeal Membrane Oxygenation for Congenital Diaphragmatic Hernia: A Single Center Experience in Turkey

Acta Medica ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 1-7
Author(s):  
Ulas Kumbasar ◽  
Ahmet Aydin ◽  
Zeynelabidin Ozturk ◽  
Recep Oktay Peker ◽  
Saniye Ekinci ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Life Support ◽  
Limb Ischemia ◽  
Right Atrial ◽  
Diagnostic Laboratory ◽  
Membrane Oxygenation ◽  
Single Center Experience ◽  
Va Ecmo

Objective: Extracorporeal membrane oxygenation (ECMO) is a temporary life-support modality offered for stabilizing neonates with congenital diaphragmatic hernia (CDH) who are in a critical condition and unresponsive to optimal medical therapy. The aim of this study was to examine our institutional outcomes of early CDH repair on ECMO. Materials and Methods: A total of 17 ECMO-supported patients with CDH were evaluated and the demographic, diagnostic, laboratory, clinical data, complications and outcome of the patients were reported. Results: The study consisted of 7 females and 10 males. Mean birth weight (BW) was 3107 g (range, 2360–3840 g). Median age of ECMO initiation was 2.1 days. In total four patients received VV ECMO. Other patients received VA ECMO via aortic and right atrial cannulation. The mean duration of ECMO was 25 days (range: 1-140 days). Six patients (35.2%) could be weaned from ECMO. The most common ECMO related complications were hemorrhage, disseminated intravascular coagulation (DIC) and limb ischemia (64.7%, 41.1% and 29.4%, respectively). Diaphragmatic defect was repaired via a subcostal incision in 12 of 13 patients. In 88.2% of patients diaphragmatic repair was performed with polytetrafluoroethylene patch. In 77% of patients early CDH repair was performed concomitantly with ECMO insertion. The survival rate was 17.6%. Conclusion: Early repair of CDH in neonates on ECMO can be associated with high rates of morbidity and mortality. However, ECMO may be considered a life-saving measure for patients with CDH who would have otherwise not been salvageable.

Abstract 16208: Safety and Efficacy of Arterio-venous Extracorporeal Membrane Oxygenation (SAVE Study) Cannulation by Interventional Cardiologists for Pediatric Population: Results of a Single Center Pilot Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Cihangir Buyukgoz ◽  
Hitesh Sandhu ◽  
Katherine Rower ◽  
Benjamin Waller ◽  
Umar Boston ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Femoral Artery ◽  
Tertiary Care ◽  
Routine Practice ◽  
Safety And Efficacy ◽  
Membrane Oxygenation ◽  
Vein Access ◽  
Cannulation Site ◽  
Va Ecmo

Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulations have been successfully performed in adults by interventional cardiologists (IC) for cardiopulmonary resuscitation (CPR) but little data exists in children. Hypothesis: This study aimed to describe the safety and efficacy of ultrasound-guided percutaneous VA-ECMO cannulation performed by IC for cardiopulmonary resuscitation. Methods: VA-ECMO cannulation performed by IC for CPR between January 2018 - June 2020 in a tertiary care children’s hospital were reviewed. Efficacy was defined as successful initiation of VA-ECMO following CPR without a surgical cut-down. Safety was defined as the absence of the need for additional procedures related to the cannulation event. Results: Eight VA-ECMO cannulations were attempted on 7 patients with 100% success; 1 patient was cannulated twice at 2 separate CPR events. Patients had congenital heart disease (n=3), idiopathic pulmonary hypertension (n=1), T-cell lymphoma (n=1) and dilated cardiomyopathy (n=2). Median age was 15 (6-18) years, median weight was 74 (16-109) kg. Uninterrupted CPR occurred during all cannulations. All cannulations were performed from left femoral artery and right femoral vein, 4 (50%) cannulations included additional internal jugular vein access. Reperfusion cannulation for distal limb circulation was also performed percutaneously by IC for 5 cannulations. Median venous cannula size was 22 (15-25) Fr and median arterial cannula size was 17 (15-17) Fr. Median cannulation start time to ECMO flow was 34.5 (18-112) min. Median ECMO duration was 3 (0.3-50) days. Survival at ECMO decannulation was 75% with a 30-day survival of 87.5%. The overall complication rate was 12.5%. One patient developed hematoma at cannulation site that was conservatively managed, and 1 patient (16 kg) developed avulsion of the intima of the left common femoral artery that needed repair. A cardiovascular surgeon was available or present during all ECMO cannulations. Conclusions: Pediatric VA-ECMO cannulation for CPR can be performed safely and efficiently by IC without interruption. Larger studies and further investigations are necessary especially in smaller children before advocating for its routine practice.

Ultrasound-Measured Femoral Arterial/Venous Parameters for Guiding Extracorporeal Membrane Oxygenation (ECMO) Catheterization

2021 ◽  
Vol 11 (8) ◽  
pp. 2253-2257
Author(s):  
Hao Zhou ◽  
Yong Mei ◽  
Jinru Lv ◽  
Wei Li ◽  
Gang Zhang ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Femoral Artery ◽  
Anatomic Variation ◽  
Common Femoral Artery ◽  
Pubic Symphysis ◽  
Membrane Oxygenation ◽  
Inner Diameter ◽  
The Common ◽  
And Gender ◽  
Arterial Branch

The femoral artery/vein are commonly used for vascular access in clinical practice. The position, adjoining relationship, and anatomic variation of the femoral artery/vein may affect the success rate of catheterization. Clinically, we found a proportion of anatomic variations in the common position of the femoral artery catheterization. We intended to determine the positioning data of the femoral artery/vein to provide a partial clinical basis for catheterization by ultrasound. At the common femoral artery catheterization site, we used ultrasound to collect data on the femoral artery/vein of 208 samples. We found that the distance from the midpoint of the pubic symphysis to the surface position of the femoral artery, the distance between the central points of the femoral artery/vein, and the inner diameter of the femoral artery were significantly correlated with height, weight, and gender, and were not correlated with age, shock, hypertension, diabetes, and coronary heart disease. If branching of the femoral artery was higher than the inguinal ligament, the inner diameter of the femoral artery at the catheterization site was significantly reduced. We believe that height, weight, gender, and anatomic variation are important factors influencing the adjoining relationship and the inner diameter of the femoral artery. During extracorporeal membrane oxygenation (ECMO) catheterization, if an arterial branch is found at the femoral artery catheterization site, it is recommended to adjust the catheterization protocol.

Improved Angiographic Findings of Superficial Femoral Artery after Verapamil Injection into the Reperfusion Cannula of a Patient on Peripheral Venoarterial ECMO

2014 ◽  
Vol 17 (5) ◽  
pp. 261 ◽  
Author(s):  
Christopher Gordon ◽  
Ali Ghodsizad ◽  
Christoph Brehm ◽  
Michael M. Koerner ◽  
Aly El-Banayosy
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Limb Ischemia ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Angiographic Findings

Limb ischemia is a complication that can occur in patients requiring percutaneously placed venoarterial extracorporeal membrane oxygenation (ECMO). One method used to prevent limb ischemia is the placement of an antegrade catheter into the superficial femoral artery. We describe a case is which the angiographic findings of the superficial femoral artery were improved by the injection of verapamil in a patient with limb ischemia.

scholarly journals Preclosing of the femoral artery allows total percutaneous venoarterial extracorporeal membrane oxygenation and prevents groin wound infection after lung transplantation

2020 ◽  
Vol 58 (2) ◽  
pp. 371-378 ◽  
Author(s):  
Quentin Pellenc ◽  
Antoine Girault ◽  
Arnaud Roussel ◽  
Sonia Aguir ◽  
Pierre Cerceau ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplantation ◽  
Wound Infection ◽  
Femoral Artery ◽  
Vascular Complications ◽  
Open Approach ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Vascular Closure Devices ◽  
Va Ecmo

Abstract OBJECTIVES In lung transplantation (LT), femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) usually requires an open approach that may be associated with severe groin wound infection. In endovascular aortic procedures, preclosing of the femoral artery (PFA) with vascular closure devices allows the percutaneous insertion and withdrawal of large-bore cannulae. We sought to evaluate whether this innovative technique could be applied in the specific setting of LT to achieve total percutaneous VA-ECMO and decrease groin wound infection. METHODS We conducted a retrospective study of a prospective database including patients who underwent LT in our centre from January 2011 to December 2017. Patients who underwent peripheral VA-ECMO using the PFA technique after January 2014 (PFA group, n = 106) were compared to those who underwent peripheral VA-ECMO using open cannulation and/or decannulation before January 2014 (non-PFA group, n = 48). The primary end point was the rate of technical success defined as total percutaneous VA-ECMO. Secondary end points included groin wound infections and delayed vascular complications. RESULTS The PFA technique was technically successful in 98 patients (92.5%). As compared with the non-PFA group, the PFA group was characterized by a similar rate of vascular complications (16.6% vs 11.3%, P = 0.360) and a decreased rate of groin wound infection (18.9% vs 0%, P &lt; 0.001). In multivariate analysis, risk factors associated with vascular complications following PFA included female sex, peripheral arterial disease and ECMO duration. CONCLUSIONS In LT patients, PFA is associated with a high rate of total percutaneous VA-ECMO, thus preventing the occurrence of groin wound infection.

Sign in / Sign up

Export Citation Format

Share Document