title: Routine Use of Distal Arterial Perfusion in Pediatric Femoral Venoarterial Extracorporeal Membrane Oxygenation.
abstract: Lower-extremity ischemia is a significant complication in children on femoral venoarterial extracorporeal membrane oxygenation (VA ECMO). Our institution currently routinely uses distal perfusion catheters (DPCs) in all femoral arterial cannulations in attempts to reduce ischemia. We performed a single-center, retrospective review of pediatric patients supported with femoral VA ECMO from January 2005 to November 2015. The outcomes of patients with prophylactic DPC placement at cannulation (prophylactic DPC) were compared to a historical group with DPCs placed in response only to clinically evident ischemic changes (reactive DPC). Ischemic complication requiring invasive intervention (fasciotomy or amputation) was the primary outcome. Twenty-nine patients underwent a total of 31 femoral arterial cannulations, 17 with prophylactic DPC and 14 with reactive DPC. Ischemic complications requiring invasive intervention developed in 2 of 17 (12%) prophylactic DPC patients versus 4 of 14 (29%) reactive DPC. In the reactive DPC group, 7 of 14 (50%) had ischemic changes postcannulation, six underwent DPC placement, and three out of six of these patients still required invasive intervention. One of the seven patients had ischemic changes, did not undergo DPC, and required amputation. While a greater percentage of patients in the prophylactic group was cannulated during extracorporeal cardiopulmonary resuscitation (ECPR), statistical significance was not otherwise demonstrated. We demonstrate feasibility of superficial femoral artery (SFA) access in pediatric patients. We note fewer ischemic complications with prophylactic DPC placement, and observe that salvaging a limb with a reactive DPC was only successful 50% of the time. Although there was no statistical difference in the primary outcome between the two groups, limitations and confounding factors include small sample size and a greater percentage of patients in the prophylactic DPC group cannulated with ECPR in progress.
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Schad
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Fallon
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Monteagudo
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
authors.forename: Shunpei
authors.initials: S
authors.lastname: Okochi
authors.affiliation: Division of Pediatric Cardiology, Pediatric Cardiac Critical Care Medicine, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
authors.forename: Eva W
authors.initials: EW
authors.lastname: Cheung
authors.affiliation: Department of Surgery, Division of Vascular Surgery, New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Morrissey
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
authors.forename: Angela V
authors.initials: AV
authors.lastname: Kadenhe-Chiweshe
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Aspelund
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Stylianos
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
authors.forename: William
authors.initials: W
authors.lastname: Middlesworth
mesh_terms: D000293:Adolescent; D000328:Adult; D002406:Catheterization, Peripheral / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000517:prevention & control* / Q000628:therapy; D007866:Leg / Q000098:blood supply*; D008297:Male; D010477:Perfusion / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: -Extracorporeal membrane oxygenation; -Femoral artery cannulation; -Pediatric; -distal perfusion; Limb ischemia