Original article
Adult cardiac
Vascular Complications in Patients Undergoing Femoral Cannulation for Extracorporeal Membrane Oxygenation Support

https://doi.org/10.1016/j.athoracsur.2011.02.018Get rights and content

Background

Extracorporeal membrane oxygenation (ECMO) is a well-established treatment for severe cardiopulmonary failure. Patients undergoing ECMO support through femoral vessels are prone to vascular complications. The aim of this study was to evaluate such complications to outline basic technical principles for their prevention.

Methods

From January 2005 to December 2009, 174 patients underwent ECMO support through cannulation of the femoral vessels. The primary outcome was any vascular complication. Secondary outcomes were 30-day mortality and 1-year survival. A logistic regression analysis including ECMO duration, peripheral arterial disease, ECMO access (percutaneous versus open), and diabetes mellitus identified predictors for vascular complications.

Results

The venoarterial mode was used in 143 patients (82%), and venovenous in 31 patients (18%). Of the 17 (10%) observed vascular complications, 15 (88%) occurred in patients with venoarterial access, whereas 2 (12%) occurred after venovenous access (p = 0.50) Two patients who had extremity ischemia required limb amputation. Thirty-day mortality and 1-year survival rates were 63% and 26%, respectively. Peripheral arterial disease was the only strong predictor of vascular complications (odds ratio, 6.95; 95% confidence interval, 1.89 to 25.59; p = 0.003). Vascular complications were not associated with early or late mortality.

Conclusions

The incidence of vascular complications in venovenous cannulation was low, whereas in arterial cannulation, it is still considerable. Peripheral arterial disease remains a risk factor, and early involvement of vascular surgeons for open vascular exposure or alternative vascular access sites can be recommended. Vascular complications after ECMO support are not associated with higher mortality rates.

Section snippets

Patients and Methods

A retrospective review of our prospectively obtained database for ECMO devices implanted between January 2005 and December 2009 indicated 242 patients requiring temporary ECMO support. Excluding patients younger than 16 years and patients dying within 12 hours after ECMO implantation, we included 174 patients (72%) undergoing ECMO support through femoral cannulation. Patients with central or subclavian artery cannulation were excluded as well. The Institutional Ethics Committee approved our

Results

The venoarterial ECMO mode was used in 143 patients (82%). Femoral arterial access was established by percutaneous cannulation in 136 (95%) and by open vessel exposure in 7 (5%). A percutaneous venovenous mode was used in 31 patients (18%).

Comment

Early VCs were observed in 10% of our patients, without any additional midterm vascular events among patients successfully weaned from ECMO. The majority of VCs was observed in the venoarterial mode and was severe. Six compartment syndromes—three as initial clinical manifestation—and two limb amputations were observed. In patients with venovenous mode, only accidental groin hematomas appeared.

The utmost challenge for the prevention of such complications is the rapid clinical diagnosis of

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