Vascular Complications after Peripheral (V-A) ECLS Cannulation in Cardiogenic Shock

Objectives: ExtraCorporeal Life Support (ECLS) is an established therapy of heart insufficiency in therapy-resistant cardiogenic shock. The cannulation in emergency can be made through puncture of the A. femoralis and V. femoralis by specialized teams. Among the possible complications, limb ischemia in various grades remains significant. Purpose of the study was to evaluate the complications regarding the limb perfusion and their treatment among the patients of our center.

Methods: In a retrospective study from January 1, 2012 to December 31, 2018, 98 patients with cardiogenic shock and peripheral (v-a) ECLS implantation with documented limb perfusion status were identified and analyzed. Demographic and laboratory data, cause of the cardiogenic shock, comorbidities, problems regarding limb perfusion, and their treatment were analyzed.

Results: Fifty-three patients (54%) received the ECLS cannulation out of hospital, while 45 (46%) in our hospital (in the emergency room). Mean age was 55,8 years (18–86 years) with 70% male/30% female distribution. The peripheral ECLS insertion was percutaneous in 83 (85%) and surgical in 15 patients (15%). Seventy-one patients (72%) had primarily a distal limb perfusion cannula (group A), whereas 27 (28%) initially did not have one (group B). Forty-four patients (45%) showed limb ischemia as a complication of ECLS therapy (22 in group A-31% and 22 in group B-81%). Fourteen of the 27 patients in group B (52%) received a distal limb perfusion cannula at a later timepoint. 20 patients (20%) were switched to central ECLS and reconstruction of the femoral vessels (10 in group A-14% and 10 in group B-37%). The mean duration of the ECLS therapy was 100 hours (107 hours in group A und 81 hours in group B). A compartment syndrome with fasciotomy was present in nine patients (9%; four in group A: 6%; and five in group B: 19%). Furthermore three patients (3%) had an amputation (two in group A: 3%; and 1 in group B: 4%).

Conclusion: Limb ischemia remains a serious complication after peripheral (v-a) ECLS cannulation, especially when a distal limb perfusion cannula is absent. Introduction of standardized use of small arterial cannula (15 Fr), obligatory distal limb perfusion cannula as well as strict hourly observation protocol by doctors and nurses showed a beneficial effect. A consistent control of the limb perfusion, a rapid reaction to clinical symptoms and an interdisciplinary cooperation contribute to avoid long-term serious problems.

No conflict of interest has been declared by the author(s).