The Utility of Preemptive Distal Perfusion Cannulation During Peripheral Venoarterial Extracorporeal Membrane Oxygenation Support.
OBJECTIVE
We compared the ischemia and rescue rates according to the strategy of distal cannulation.


BACKGROUND
Limb ischemia developing during percutaneous venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is a potentially severe complication. Although appropriate use of a distal perfusion cannula can avoid ischemia, evidences about distal cannulation is still lacking.


METHODS
Patients who underwent peripheral VA ECMO between January 2010 and August 2015 were reviewed. We classified patients into 2 groups in terms of insertion timing with respect to the onset of ischemia. The preemptive strategy group underwent early insertion of a distal perfusion cannula at commencement of ECMO support. The rescue strategy group underwent delayed cannula insertion after onset of limb ischemia.


RESULTS
A total of 151 patients were included in the analysis. Forty-four patients formed the preemptive strategy group and 107 patients formed the rescue strategy group. In total, 10 of 151 (6.7%) patients developed significant limb ischemia, they all were the rescue strategy group (10/107, 9.3%). Of the 10 patients, 2 patients were rescued from limb ischemia after distal cannulation. Otherwise, ischemia was not rescued in the remaining eight patients. Of the latter 8, 3 patient required surgical interventions (2 fasciotomy and 1 below-the-knee amputation) and the other five died from disease aggravation prior to surgical intervention.


CONCLUSIONS
Preemptive distal perfusion cannulation is safe and effective when used to prevent lower limb ischemia in patients undergoing femoral cannulation to treat ECMO. However, delayed distal cannulation increases the extent of cannulation site bleeding, without improving the ischemia.
Department of Pulmonary, Allergy and Critical Care Medicine, Pusan National University Yangsan Hospital, The Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Hye Ju
HJ
Yeo
Department of Pulmonary, Allergy and Critical Care Medicine, Pusan National University Yangsan Hospital, The Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Seong Hoon
SH
Yoon
Department of Pulmonary, Allergy and Critical Care Medicine, Pusan National University Yangsan Hospital, The Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Doosoo
D
Jeon
Department of Pulmonary, Allergy and Critical Care Medicine, Pusan National University Yangsan Hospital, The Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Yun Seong
YS
Kim
Department of Pulmonary, Allergy and Critical Care Medicine, Pusan National University Yangsan Hospital, The Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Woo Hyun
WH
Cho
Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, The Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Dohyung
D
Kim
Department of Pulmonary, Allergy and Critical Care Medicine, Pusan National University Yangsan Hospital, The Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Seung Eun
SE
Lee
D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D057186:Comparative Effectiveness Research; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D020379:Risk Adjustment / Q000379:methods; D013997:Time Factors