Local and Lower Limb Complications during and after Femoral Cannulation for Extracorporeal Life Support
20 July 2017
05 October 2017
24 November 2017 (online)
Objective The extracorporeal life support system (ECLS) system is a lifesaving option for patients in pulmonary and/or cardiac failure. We reviewed our data on local complications in the leg and groin during and after ECLS explantation.
Methods Patients were included when an ECLS was cannulated in the groin and the ECLS was successfully weaned and explanted. Data were collected retrospectively in patients from January 2013 to January 2016.
Results In this study, 90 patients were included; 39 (43%) ECLS were implanted with surgical cut down and 51 (57%) ECLS were implanted percutaneously. Most patients needed ECLS support following cardiac surgery: cut down: 25 (64%) versus percutaneous: 28 (55%) (p = 0.40). A distal leg perfusion cannula was implanted simultaneously in 61 (68%) patients (cut down: 25 [64%] vs. percutaneous: 36 [71%], p = 0.36). Distal leg ischemia was diagnosed in a total of 10 (11%) patients (cut down: 2 [5%] vs. percutaneous: 8 [16%], p = 0.18). Of those 10 patients, 5 patients had leg ischemia despite a distal leg perfusion cannula in place (cut down: 1 [3%] vs. percutaneous: 4 [8%], p = 0.38). Revascularization was successfully achieved in all patients and no amputations had to be performed. Similar rates of wound healing disorders were observed in both groups: cut down: 11 (28%) versus percutaneous: 10 (20%) patients (p = 0.45).
Conclusion Surgical and percutaneous implantation and explantation of ECLS are safe and feasible with comparable complication rates, including wound healing disorders. We recommend that a lower limb perfusion cannula should be placed to prevent leg ischemia. Surgical cut-down placement of the distal leg perfusion cannula may reduce the incidence of distal leg ischemia compared with percutaneous distal leg cannula implantation. Correct placement of the cannula should be controlled.
- 1 Xie A, Phan K, Tsai YC, Yan TD, Forrest P. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest: a meta-analysis. J Cardiothorac Vasc Anesth 2015; 29 (03) 637-645
- 2 Guenther SP, Brunner S, Born F. , et al. When all else fails: extracorporeal life support in therapy-refractory cardiogenic shock. Eur J Cardiothorac Surg 2016; 49 (03) 802-809
- 3 Clark JB, Wang S, Palanzo DA. , et al. Current techniques and outcomes in extracorporeal life support. Artif Organs 2015; 39 (11) 926-930
- 4 von Keudell AG, Weaver MJ, Appleton PT. , et al. Diagnosis and treatment of acute extremity compartment syndrome. Lancet 2015; 386 (10000): 1299-1310
- 5 Dalton HJ, Garcia-Filion P, Holubkov R. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Association of bleeding and thrombosis with outcome in extracorporeal life support. Pediatr Crit Care Med 2015; 16 (02) 167-174
- 6 Cheng R, Hachamovitch R, Kittleson M. , et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg 2014; 97 (02) 610-616
- 7 Hei F, Lou S, Li J. , et al. Five-year results of 121 consecutive patients treated with extracorporeal membrane oxygenation at Fu Wai Hospital. Artif Organs 2011; 35 (06) 572-578
- 8 Bakhtiary F, Keller H, Dogan S. , et al. Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: clinical experiences in 45 adult patients. J Thorac Cardiovasc Surg 2008; 135 (02) 382-388
- 9 Hsu PS, Chen JL, Hong GJ. , et al. Extracorporeal membrane oxygenation for refractory cardiogenic shock after cardiac surgery: predictors of early mortality and outcome from 51 adult patients. Eur J Cardiothorac Surg 2010; 37 (02) 328-333
- 10 Rastan AJ, Dege A, Mohr M. , et al. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg 2010; 139 (02) 302-311 , 311.e1
- 11 Zhang R, Kofidis T, Kamiya H. , et al. Creatine kinase isoenzyme MB relative index as predictor of mortality on extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients. Eur J Cardiothorac Surg 2006; 30 (04) 617-620
- 12 Kim H, Lim SH, Hong J. , et al. Efficacy of veno-arterial extracorporeal membrane oxygenation in acute myocardial infarction with cardiogenic shock. Resuscitation 2012; 83 (08) 971-975
- 13 Loforte A, Montalto A, Ranocchi F. , et al. Peripheral extracorporeal membrane oxygenation system as salvage treatment of patients with refractory cardiogenic shock: preliminary outcome evaluation. Artif Organs 2012; 36 (03) E53-E61
- 14 Belle L, Mangin L, Bonnet H. , et al. Emergency extracorporeal membrane oxygenation in a hospital without on-site cardiac surgical facilities. EuroIntervention 2012; 8 (03) 375-382
- 15 Moraca RJ, Wanamaker KM, Bailey SH. , et al. Salvage peripheral extracorporeal membrane oxygenation using Cobe Revolution(®) centrifugal pump as a bridge to decision for acute refractory cardiogenic shock. J Card Surg 2012; 27 (04) 521-527
- 16 Slottosch I, Liakopoulos O, Kuhn E. , et al. Outcomes after peripheral extracorporeal membrane oxygenation therapy for postcardiotomy cardiogenic shock: a single-center experience. J Surg Res 2013; 181 (02) e47-e55
- 17 Smith C, Bellomo R, Raman JS. , et al. An extracorporeal membrane oxygenation-based approach to cardiogenic shock in an older population. Ann Thorac Surg 2001; 71 (05) 1421-1427
- 18 Unosawa S, Sezai A, Hata M. , et al. Long-term outcomes of patients undergoing extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. Surg Today 2013; 43 (03) 264-270
- 19 Vallabhajosyula P, Kramer M, Lazar S. , et al. Lower-extremity complications with femoral extracorporeal life support. J Thorac Cardiovasc Surg 2016; 151 (06) 1738-1744
- 20 Bermudez CA, Rocha RV, Toyoda Y. , et al. Extracorporeal membrane oxygenation for advanced refractory shock in acute and chronic cardiomyopathy. Ann Thorac Surg 2011; 92 (06) 2125-2131
- 21 Hwang JW, Yang JH, Sung K. , et al. Percutaneous removal using Perclose ProGlide closure devices versus surgical removal for weaning after percutaneous cannulation for venoarterial extracorporeal membrane oxygenation. J Vasc Surg 2016; 63 (04) 998-1003.e1
- 22 Sun HY, Ko WJ, Tsai PR. , et al. Infections occurring during extracorporeal membrane oxygenation use in adult patients. J Thorac Cardiovasc Surg 2010; 140 (05) 1125-32.e2
- 23 Schmidt M, Bréchot N, Hariri S. , et al. Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Clin Infect Dis 2012; 55 (12) 1633-1641