title: Does a distal perfusion cannula reduce ischaemic complications of extracorporeal membrane oxygenation?
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) provides support to patients with severe but reversible cardiac or pulmonary failure. Vascular complications of ECMO are well recognized.
  
  
  METHODS
  We performed a retrospective review of 70 patients (mean age 48 years; 15-85) who received peripheral veno-arterial ECMO from 2004 to 2010 in a single centre. For statistical analysis, chi-squared test and multivariate binary logistic regression analysis were used to assess for association between response variables (i.e. limb ischaemia, ECMO site bleeding and deep vein thrombosis (DVT)) and possible predictive variables.
  
  
  RESULTS
  There were 14 (20%) cases of acute limb ischaemia with no statistically significant relationship between acute limb ischaemia and independent variables. Thirty-three patients received distal limb cannulas (47%). There was no statistically significant association between limb ischaemia and presence of distal limb cannula (P = 0.8). Multivariate binary logistic regression analysis identified insertion by cutdown as a predictor of lower probability of insertion site bleeding (n = 12, odds ratio 0.24, P = 0.04). Seven cases of DVT were identified; multivariate binary logistic regression analysis identified insertion by cutdown (odds ratio 0.08, P = 0.03) and days of ECMO less than five (odds ratio 0.08, P = 0.04) as predictive factors for reduced rates of DVT.
  
  
  CONCLUSIONS
  Ischaemic complications of ECMO are common and occur despite the presence of a distal limb-perfusing cannula; however in our study the distal limb cannula was a limb-salvaging intervention in six patients. Prolonged time on ECMO is a risk factor for DVT, and a high index of suspicion must be maintained. Percutaneous insertion was associated with higher rates of bleeding and DVT.
authors.affiliation: St Vincent's Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Robert Wai-Leung
authors.initials: RW
authors.lastname: Ma
authors.affiliation: School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia.|St Vincent's Hospital, Darlinghurst, New South Wales, Australia.
authors.forename: Ravi L
authors.initials: RL
authors.lastname: Huilgol
authors.affiliation: St Vincent's Hospital, Darlinghurst, New South Wales, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Granger
authors.affiliation: St Vincent's Hospital, Darlinghurst, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jackson
authors.affiliation: St Vincent's Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: Saling
authors.affiliation: St Vincent's Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Dower
authors.affiliation: St Vincent's Hospital, Darlinghurst, New South Wales, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Nivison-Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072601:Cannula; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000517:prevention & control*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: cardiothoracic surgery; emergency medicine; extracorporeal membrane oxygenation; intensive care; other categories; vascular surgery