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Early Vascular Surgery Consultation in Patients Undergoing Extracorporeal Membrane Oxygenation
Calin Manea, MD, Nadj Pierre, MD, Kevin Markose, MD, Shivik Patel, MD.
Wellspan Health York Hospital, York, PA, USA.

OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) is an important management tool in patients with severe cardiopulmonary compromise. Patients undergoing large-bore femoral arterial cannulation are at an increased risk of vascular complications. The incidence of major adverse limb events (MALE), including arterial intervention and amputation, following ECMO therapy ranges from 9.4-43.9% in recent literature. At our institution we place emphasis on early vascular consultation for patients with known peripheral arterial disease undergoing ECMO as part of a multi-disciplinary approach. The purpose of this study was to retrospectively evaluate our institutionís experience with MALE following ECMO therapy and identify pathways for improvement.
METHODS: From August 2018 to August 2023 a total of 69 patients underwent ECMO support and subsequent decannulation at our institution. The primary outcomes were presence of MALE and 30-day mortality. Multivariate analysis included sex, BMI, hypertension, chronic kidney disease, presence of underlying peripheral arterial disease (PAD), diabetes mellitus, ECMO therapy duration, and presence of distal perfusion catheter.
RESULTS: There were a total of 69 subjects, 44 male and 25 female. The overall rate of MALE was 21.7% and a 30-day mortality of 33%. History of PAD was significantly associated with MALE following ECMO (p=0.002). Increased age was found to be a predictive variable in 30-day mortality (p=0.016). No significant associations were seen between BMI, duration of ECMO therapy, and presence of distal perfusion catheter in relation to the primary outcomes.
CONCLUSIONS: The rate of MALE following ECMO therapy at our institution was 21.7%, which is within range of recently cited literature. In patient with severe cardiovascular disease undergoing ECMO, early vascular consultation for PAD should be encouraged as part of a multidisciplinary approach for limb preservation.


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