The Utility of Preemptive Distal Perfusion Cannulation During Peripheral Venoarterial Extracorporeal Membrane Oxygenation Support

医学 套管 缺血 体外膜肺氧合 外科 肢体灌注 灌注 肢体缺血 截肢 经皮 筋膜切开术 麻醉 并发症 禁忌症 心脏病学 内科学 不利影响 替代医学 病理
作者
Hye Ju Yeo,Seong Hoon Yoon,Doosoo Jeon,Yun Seong Kim,Woo Hyun Cho,Dohyung Kim,Seung Eun Lee
出处
期刊:Journal of Interventional Cardiology [Hindawi Limited]
卷期号:29 (4): 431-436 被引量:34
标识
DOI:10.1111/joic.12309
摘要

We compared the ischemia and rescue rates according to the strategy of distal cannulation.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.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.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.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.
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