title: Limb ischemia during femoral cannulation for cardiopulmonary support.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation and extracorporeal cardiopulmonary support (ECMO/CPS) are potentially life-saving techniques for patients with cardiopulmonary collapse. Complications include lower extremity ischemia from femoral artery cannulation. We examined the outcomes of patients placed on ECMO/CPS, including the rate of limb ischemia.
  
  
  METHODS
  All instances of ECMO/CPS over a 3-year period (2006-2009) at a single university hospital were examined retrospectively for cannulation strategy, perfusion strategy, mortality, and limb ischemia. Potential predictors of limb ischemia with femoral artery cannulation were age, gender, body surface area (BSA), body mass index (BMI), and arterial cannula size.
  
  
  RESULTS
  Fifty-eight patients were placed on ECMO/CPS. Of these, 43 patients (74%) had femoral arterial cannulation. In 10 patients, the superficial femoral artery (SFA) was cannulated prophylactically (without antecedent limb ischemia) and perfused in the antegrade direction from a branch of the ECMO/CPS circuit. In 7 of the remaining 33 patients (21%), limb ischemia developed requiring decannulation with fasciotomy (n = 4) or additional cannulation of the SFA with branching of the ECMO/CPS circuit (n = 3). One patient with ipsilateral leg ischemia required eventual amputation. Patients with limb ischemia were significantly younger than those who did not develop limb ischemia (P = .001). BSA, BMI, and cannula size did not predict limb ischemia. Overall 30-day mortality following the initiation of ECMO/CPS was 79%. There was no correlation between limb ischemia and mortality.
  
  
  CONCLUSIONS
  Younger patients may be at increased risk for lower extremity arterial insufficiency with femoral cannulation for ECMO/CPS. Prophylactic or expectant SFA cannulation are reasonable approaches.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. foleyp@uphs.upenn.edu
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Foley
authors.forename: Rohinton J
authors.initials: RJ
authors.lastname: Morris
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Woo
authors.forename: Michael A
authors.initials: MA
authors.lastname: Acker
authors.forename: Grace J
authors.initials: GJ
authors.lastname: Wang
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Fairman
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000401:mortality; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000401:mortality; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005263:Femoral Artery; D006785:Hospitals, University; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult