https://doi.org/10.4081/amsa.2023.15

Distal perfusion cannula on VA-ECMO: do not blindly trust! A case report

Vol. 1 No. 1 (2023)
Submitted: 5 April 2023
Accepted: 22 April 2023
Published: 16 May 2023
ECMO, ECLS, ECPR, NIRS, distal perfusion cannula
Abstract Views: 801
PDF: 438
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Authors

Rodrigo Diaz
rodrigoa.diaz@redsalud.cl
https://orcid.org/0000-0001-8046-2229
Pabellon Central, Red Salud Santiago, Pabellon Central, Santiago, Chile.
Marta Velia Antonini
https://orcid.org/0000-0003-4276-3404
Anesthesia and Intensive Care Unit, Bufalini Hospital - AUSL della Romagna, Cesena; Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy.

Distal perfusion cannulas, DPCs, are increasingly used to prevent limb ischemia, frequent and potentially serious complication on peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support. We report the case of a patient treated with femoro-femoral V-A ECMO who developed a sudden, significant asymmetric decrease in cannulated limb regional oxygen saturation, rSO2, signal, despite the presence of a DPC. This finding, noticed within 6 hours after the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) in a patient experiencing refractory intra-hospital cardiac arrest (IHCA), suggested ongoing limb ischemia. After careful monitoring, a clot was detected in the line supplying DPC, which appeared completely kinked at dressing removal. Line patency and reperfusion were promptly re-established. No additional ischemic episodes occurred, and the patient was successfully weaned from extracorporeal support, and experienced full functional recovery, with no sensory or motor deficit.

This case highlights the strict need for a careful, continuous monitoring of limb perfusion during V-A ECMO, even if limb perfusion through DPC is implemented, in order to prevent severe limb complications, negatively impacting on outcome.

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Google Scholar
Europe PMC
Bonicolini E, Martucci G, Simons J, et al. Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment. Crit Care 2019;23:266. DOI: https://doi.org/10.1186/s13054-019-2541-3
Extracorporeal Life Support Organization (ELSO) Registry International Summary, October, 2022, reporting data through 2021. Available from: https://www.elso.org/registry/internationalsummaryandreports/internationalsummary.aspx accessed on March 2022
Yen CC, Kao CH, Tsai CS, Tsai SH. Identifying the risk factor and prevention of limb ischemia in extracorporeal membrane oxygenation with femoral artery cannulation. Heart Surg Forum 2018;21:E018-E022. DOI: https://doi.org/10.1532/hsf.1824
Yau P, Xia Y, Shariff S, et al. Factors associated with ipsilateral limb ischemia in patients undergoing femoral cannulation extracorporeal membrane oxygenation. Ann Vasc Surg 2019;54:60-65. DOI: https://doi.org/10.1016/j.avsg.2018.08.073
Wilhelm MJ, Inderbitzin DT, Malorgio A, et al. Acute limb ischemia after femoro-femoral extracorporeal life support implantation: A comparison of surgical, percutaneous, or combined vascular access in 402 patients. Artif Organs 2022;46:2284-92. DOI: https://doi.org/10.1111/aor.14344
Lamb KM, DiMuzio PJ, Johnson A, et al. Arterial protocol including prophylactic distal perfusion catheter decreases limb ischemia complications in patients undergoing extracorporeal membrane oxygenation. J Vasc Surg 2017;65:1074-9. DOI: https://doi.org/10.1016/j.jvs.2016.10.059
Chanan EL, Bingham N, Smith DE, Nunnally ME. Early detection, prevention, and management of acute limb ischemia in adults supported with venoarterial extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth 2020;S1053-0770(20)30178-6.
Kaufeld T, Beckmann E, Ius F, et al. Risk factors for critical limb ischemia in patients undergoing femoral cannulation for venoarterial extracorporeal membrane oxygenation: Is distal limb perfusion a mandatory approach? Perfusion 2019;34:267659119827231. DOI: https://doi.org/10.1177/0267659119827231
Ranney DN, Benrashid E, Meza JM, et al. Vascular complications and use of a distal perfusion cannula in femorally cannulated patients on extracorporeal membrane oxygenation. ASAIO J 2018;64:328–33. DOI: https://doi.org/10.1097/MAT.0000000000000656
Spurlock DJ, Toomasian JM, Romano MA, et al. A simple technique to prevent limb ischemia during veno-arterial ECMO using the femoral artery: the posterior tibial approach. Perfusion 2012;27:141-5. DOI: https://doi.org/10.1177/0267659111430760
Gajkowski EF, Herrera G, Hatton L, et al. ELSO guidelines for adult and pediatric extracorporeal membrane oxygenation circuits. ASAIO J 2022;68:133-52. DOI: https://doi.org/10.1097/MAT.0000000000001630
Kim DJ, Cho YJ, Park SH, et al. Near-infrared spectroscopy monitoring for early detection of limb ischemia in patients on veno-arterial extracorporeal membrane oxygenation. ASAIO J 2017;63:613‐7. DOI: https://doi.org/10.1097/MAT.0000000000000532
Castro DM, Morris I, Teijeiro-Paradis R, Fan E. Monitoring during extracorporeal membrane oxygenation. Curr Opin Crit Care 2022;28:348-359. DOI: https://doi.org/10.1097/MCC.0000000000000939
Gagnier JJ, Kienle G, Altman DG, et al. The CARE guidelines: consensus-based clinical case reporting guideline development. BMJ Case Rep 2013;2013:bcr2013201554. DOI: https://doi.org/10.1136/bcr-2013-201554

How to Cite

Diaz, R., & Antonini, M. V. (2023). Distal perfusion cannula on VA-ECMO: do not blindly trust! A case report. Acute Care Medicine Surgery and Anesthesia, 1(1). https://doi.org/10.4081/amsa.2023.15
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