• Hye Ju Yeo, YoonSeong HoonSHDepartment of Pulmonary, Allergy and Critical Care Medicine, Pusan National University Yangsan Hospital, The Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Kore, Doosoo Jeon, Yun Seong Kim, Woo Hyun Cho, Dohyung Kim, and Seung Eun Lee.
• Department of Pulmonary, Allergy and Critical Care Medicine, Pusan National University Yangsan Hospital, The Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
• J Interv Cardiol. 2016 Aug 1; 29 (4): 431-6.

ObjectivesWe compared the ischemia and rescue rates according to the strategy of distal cannulation.BackgroundLimb ischemia developing during percutaneous venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is a potentially severe complication. Although appropriate use of a distal perfusion cannula can avoid ischemia, evidences about distal cannulation is still lacking.MethodsPatients who underwent peripheral VA ECMO between January 2010 and August 2015 were reviewed. We classified patients into 2 groups in terms of insertion timing with respect to the onset of ischemia. The preemptive strategy group underwent early insertion of a distal perfusion cannula at commencement of ECMO support. The rescue strategy group underwent delayed cannula insertion after onset of limb ischemia.ResultsA total of 151 patients were included in the analysis. Forty-four patients formed the preemptive strategy group and 107 patients formed the rescue strategy group. In total, 10 of 151 (6.7%) patients developed significant limb ischemia, they all were the rescue strategy group (10/107, 9.3%). Of the 10 patients, 2 patients were rescued from limb ischemia after distal cannulation. Otherwise, ischemia was not rescued in the remaining eight patients. Of the latter 8, 3 patient required surgical interventions (2 fasciotomy and 1 below-the-knee amputation) and the other five died from disease aggravation prior to surgical intervention.ConclusionsPreemptive distal perfusion cannulation is safe and effective when used to prevent lower limb ischemia in patients undergoing femoral cannulation to treat ECMO. However, delayed distal cannulation increases the extent of cannulation site bleeding, without improving the ischemia.© 2016, Wiley Periodicals, Inc.

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