Investigation of a Retrograde Implantation Technique for Distal Limb Perfusion during ECMO Therapy

Objectives: Lower limb ischemia is a well-recognized complication in patients treated with venoarterial extracorporeal membrane oxygenation (vaECMO). Placement of a distal perfusion catheter (DPC) may prevent this severe complication. Insertion of percutaneous DPC can be highly challenging due to emergency situation and antegrade puncture of the femoral artery. In this study we investigated the feasibility of a novel retrograde implantation technique of DPC.

Methods: Between January 2019 and July 2020, ten patients received percutaneous femoral vaECMO implantation with retrograde distal perfusion catheter. DPC was placed retrograde into the superficial femoral artery and connected to the ECMO circuit. Accurate lower extremity perfusion was documented by fluoroscopy and clinical examination. ECMO explantation was performed using vascular closure devices- or open surgical explantation.

Result: A total of 10 patients were placed on ECMO with retrograde DPC. Femoral arterial cannula sizes ranged between 17-F and 19-F. Mean duration of ECMO support was 8 days (range, 1–19 days). A percutaneous retrograde DPC was inserted prophylactically at the time of cannulation in all patients. ECMO weaning and explantation was feasible in 60% (n = 6). Two patients underwent ECMO explantation in an open surgical manner. Interventional fluoroscopy-guided explantation was performed in four patients. The explantation was performed using a vascular closure device over a guidewire. In case of closure device failure, ballooning- or stent implantation can be facilitated over the wire. Furthermore, vascular patency could be verified using fluoroscopy via retrograde DPC. After decannulation (n = 6), no patient had further evidence of limb ischemia. Overall ECMO survival rate was 50%, whereas no patient showed signs of limb ischemia.

Conclusion: Novel implantation technique of retrograde distal perfusion catheter is a save and feasible method to prevent ischemia complications of the lower limb. It can facilitate a faster and simplified implantation of DPC. Additionally, it can be helpful in interventional ECMO explantation by allowing for fluoroscopy and vascular rescue strategies.

Publication History

Article published online:
19 February 2021