Limb Complications And Survival Outcomes In Peripheral VA ECMO Patients With Limb Protection Protocol And Selective Placement Of Distal Perfusion Catheters
Emilie C. Robinson, MD, Lia Jordano, MD, Aleem Mirza, MD, Peter Eckman, MD, Katarzyna Hryniewicz, MD, Jessica Titus, MD.
Abbott Northwestern Hospital, Minneapolis, MN, USA.
OBJECTIVE Veno-arterial extracorporeal membrane oxygenation (VA ECMO) constitutes an emergent life-saving strategy for cardiopulmonary failure but portends risk of limb ischemia, as high as 70% in some reports. With the goal of reducing limb complications, our institution implemented a standard protocol which included parameters for selective distal perfusion catheter (DPC) placement. We have evaluated a preliminary data set to assess the safety of this approach. METHODS A retrospective review was conducted comprising patients on peripheral VA ECMO from January, 2019 to December, 2020 at a single institution. This study represents a collection of two-year data with our ECMO limb protection protocol in place. Patients were excluded if there was inadequate available information or if they survived less than 12 hours after cannulation. Limb outcomes including need for fasciotomy or amputation as well as overall rates of decannulation and mortality were evaluated. RESULTS During the study period, 105 VA ECMO patients were identified, 60% male and 40% female with mean age of 61 years. 50% of patients were cannulated by interventional cardiology at our institution, 15% by cardiothoracic surgery and 35% at outside institutions. 61 patients (58%) had DPC placement at time of cannulation, 9 (9%) required delayed DPC placement, and 35 (33%) did not require DPC. When placed in a delayed fashion, mean time to DPC was 10 hours, 9 minutes. Of the 70 DPCs placed, there were 4 complications (5.7%) including 2 SFA dissections and 2 cases where the DPC traversed through the backwall of the SFA. 1 patient (0.9%) required fasciotomies and there were no amputations. 76 patients (72%) survived to decannulation and mean time to decannulation was 4 days, 14 hours, 50 minutes. In the remaining 29 patients (28%), mean time to death was 3 days, 6 hours, 51 minutes. Overall 30-day mortality was 46%. CONCLUSIONS This preliminary report of our two-year ECMO data suggests the selective use of DPC is safe and does not result in increased limb complications, with less than 1% requiring fasciotomy and no amputations. This allows for avoidance of DPC in over one-third of patients, decreasing potential complications. These results are encouraging in establishing the effectiveness of our current ECMO limb protection protocol. Additional data collection and further analysis is planned to evaluate comprehensive outcomes.
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