Arterial complications in patients undergoing extracorporeal membrane oxygenation via femoral cannulation.
BACKGROUND
Extracorporeal membrane oxygenation (ECMO) provides continuous cardiopulmonary support on a long-term basis. It has been speculated that patients undergoing ECMO via femoral arterial cannulation are more likely to develop peripheral vascular complications. The purpose of this study was to evaluate the incidence of peripheral vascular complications in this group of patients and outline the modalities used for treatment.


METHODS
Data were collected for all patients who had femoral artery cannulation for ECMO therapy from June 2008 to October 2011. Primary outcome was any vascular complication. Secondary outcomes were 30-day mortality and amputation. Operative reports were reviewed to analyze the surgical procedures implied for treating vascular complications.


RESULTS
One hundred one patients underwent ECMO therapy during the period of study; 63.4% were male with an average age of 47.7 years. Mean length of hospital stay was 19.8 days and average length of time on the ECMO device was 7.33 days. Indications for ECMO included cardiogenic shock in 61 patients (60.4%), pulmonary failure in 37 (36.6%), and combined cardiac and pulmonary failure in 3 (3%). Overall mortality comprised 42 patients (42%). Risk factors for peripheral arterial disease included hypertension (32%), diabetes mellitus (21.8%), hyperlipidemia (21.7%), and smoking (19.8%). Eighteen patients (17.8%) developed peripheral vascular complications (confidence interval 10‒25%). Among the patients who developed vascular complications, 78% were male and average length of time on the device was 7.16 days. Indications for ECMO were cardiac failure in 13 (72%) and pulmonary failure in 5 (28%). Two (11%) were managed nonoperatively and 16 (89%) needed surgical intervention, 8 (44.44%) of whom required femoral endarterectomy with patch angioplasty. One patient required below-knee amputation. None required distal bypass. Mortality among patients with vascular complications was 28% (P = 0.30). Indications for use of ECMO in these patients included cardiogenic shock in 13 (72%) and pulmonary failure in 5 (28%). The mortality rate was 58% among diabetic patients and 34% in nondiabetic patients (P = 0.007).


CONCLUSIONS
Vascular complications occur in less then 20% of ECMO patients with the majority requiring femoral reconstruction. Development of vascular complications does not appear to increase risk of amputation or mortality. Among those patients who develop vascular complications, the most common indication for ECMO is cardiogenic shock.
Section of Vascular Surgery, Department of Surgery, Heart & Vascular Institute, Pennsylvania State University, Hershey, PA. Electronic address: faziz@hmc.psu.edu.
Faisal
F
Aziz
Heart & Vascular Intensive Care Unit, Heart & Vascular Institute, Pennsylvania State University, Hershey Medical Center, Hershey, PA.
Christoph E
CE
Brehm
Heart & Vascular Intensive Care Unit, Heart & Vascular Institute, Pennsylvania State University, Hershey Medical Center, Hershey, PA.
Aly
A
El-Banyosy
Section of Vascular Surgery, Department of Surgery, Heart & Vascular Institute, Pennsylvania State University, Hershey, PA.
David C
DC
Han
Section of Vascular Surgery, Department of Surgery, Heart & Vascular Institute, Pennsylvania State University, Hershey, PA.
Robert G
RG
Atnip
Section of Vascular Surgery, Department of Surgery, Heart & Vascular Institute, Pennsylvania State University, Hershey, PA.
Amy B
AB
Reed
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000293:injuries* / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D055815:Young Adult