Dirk Lunz1, Alois Philipp2, Thomas Müller3, Karin Pfister4, Maik Foltan5, Leopold Rupprecht6, Christof Schmid7, Matthias Lubnow8, Bernhard Graf9, Barbara Sinner10. 1. Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany. Electronic address: Dirk.Lunz@ukr.de. 2. Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany. Electronic address: Alois.Philipp@ukr.de. 3. Department of Internal Medicine, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany. Electronic address: Thomas.Mueller@ukr.de. 4. Department of Vascular Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany. Electronic address: Karin.Pfister@ukr.de. 5. Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany. Electronic address: Maik.Foltan@ukr.de. 6. Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany. Electronic address: Leopold.Rupprecht@ukr.de. 7. Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany. Electronic address: Christof.Schmid@ukr.de. 8. Department of Internal Medicine, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany. Electronic address: Mattias.Lubnow@ukr.de. 9. Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany. Electronic address: Bernhard.Graf@ukr.de. 10. Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany. Electronic address: Barbara.Sinner@ukr.de.
Abstract
PURPOSE: Venoarterial (VA) ECMO is widely accepted as salvage therapy for cardio-respiratory or cardiac failure. Vascular complications from cannulation are common and potentially life-threatening. Here, we retrospectively analyzed vascular complications following VA ECMO therapy. MATERIAL AND METHODS: Patients treated with VA ECMO via femoral cannulation from 2010 to 2016 were enrolled. Patient factors, indication and procedure were retrieved from our hospital database and statistically analyzed. RESULTS: 223 patients were enrolled. Survival rate was 43, 0%. Ischemic vascular complications were seen in 43, 9%. Main manifestation (82, 7%) was stenosis or occlusion of the femoral (common and superficial) or the external iliacal artery. Embolus or dissection occurred in 4, 1%. 32, 7% patients with ischemia required surgical intervention with 24,5% suffering from compartment syndrome. An antegrade perfusion catheter was established in 50% of the patients. Patients receiving VA ECMO for extracorporeal cardiopulmonary resuscitation had the lowest ischemic rates with 28,6%. Multiple regression analysis identified only the underlying indication and the size of the cannula as significant risk factor for vascular complications. Survival rates to hospital discharge were 37,3% and 47,2% in patients with and without ischemic complications. CONCLUSIONS: Cannula size and indication setting are the most important factors for the development of ischemic complications following VA ECMO.
PURPOSE: Venoarterial (VA) ECMO is widely accepted as salvage therapy for cardio-respiratory or cardiac failure. Vascular complications from cannulation are common and potentially life-threatening. Here, we retrospectively analyzed vascular complications following VA ECMO therapy. MATERIAL AND METHODS:Patients treated with VA ECMO via femoral cannulation from 2010 to 2016 were enrolled. Patient factors, indication and procedure were retrieved from our hospital database and statistically analyzed. RESULTS: 223 patients were enrolled. Survival rate was 43, 0%. Ischemic vascular complications were seen in 43, 9%. Main manifestation (82, 7%) was stenosis or occlusion of the femoral (common and superficial) or the external iliacal artery. Embolus or dissection occurred in 4, 1%. 32, 7% patients with ischemia required surgical intervention with 24,5% suffering from compartment syndrome. An antegrade perfusion catheter was established in 50% of the patients. Patients receiving VA ECMO for extracorporeal cardiopulmonary resuscitation had the lowest ischemic rates with 28,6%. Multiple regression analysis identified only the underlying indication and the size of the cannula as significant risk factor for vascular complications. Survival rates to hospital discharge were 37,3% and 47,2% in patients with and without ischemic complications. CONCLUSIONS: Cannula size and indication setting are the most important factors for the development of ischemic complications following VA ECMO.
Authors: Christoph Fisser; Corina Armbrüster; Clemens Wiest; Alois Philipp; Maik Foltan; Dirk Lunz; Karin Pfister; Roland Schneckenpointner; Christof Schmid; Lars S Maier; Thomas Müller; Matthias Lubnow Journal: Front Med (Lausanne) Date: 2022-07-28
Authors: Sasa Rajsic; Benedikt Treml; Dragana Jadzic; Robert Breitkopf; Christoph Oberleitner; Marina Popovic Krneta; Zoran Bukumiric Journal: Ann Intensive Care Date: 2022-10-05 Impact factor: 10.318