• Razvan Dragulescu, Xavier Armoiry, Matthias Jacquet-Lagrèze, Philippe Portran, Remi Schweizer, Jean Luc Fellahi, Daniel Grinberg, Jean Francois Obadia, and Matteo Pozzi.
• Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France.
• J. Cardiothorac. Vasc. Anesth. 2023 Nov 1; 37 (11): 227222792272-2279.

ObjectivesTo analyze the incidence, clinical impact on survival, and risk factors of lower limb ischemia (LLI) of surgical peripheral femoral venoarterial extracorporeal membrane oxygenation (VA ECMO) in the current era.DesignA retrospective analysis of the authors' institutional database of VA ECMO was performed. Patients were divided into 2 groups according to the occurrence of LLI. The primary endpoint was survival to hospital discharge. Risk factors of LLI were searched with multivariate analyses.SettingUniversity hospital.ParticipantsAdult patients receiving peripheral VA ECMO for refractory cardiogenic shock and cardiac arrest.InterventionsNone.Measurements And Main ResultsFrom January 2018 to December 2021, 188 patients (mean age: 52.0 ± 14.1 years; 63.8% male, 36.2% female) received peripheral VA ECMO. Male sex was more prevalent in the group without LLI (65.9% v 33.3%; p = 0.031). Twelve (6.4%) patients developed LLI during VA ECMO support (n = 6) or after VA ECMO removal (n = 6). Survival to hospital discharge was not statistically different between patients with and without LLI (50.0% v 48.3%; p = 0.571). Female sex patients were at increased risk for LLI (odds ratio 4.38, 95% CI 1.21-15.81; p = 0.024).ConclusionsPeripheral femoral VA ECMO through a surgical approach is associated with a low LLI rate, which does not increase the risk of in-hospital mortality. The female sex is an independent risk factor for LLI.Copyright © 2023 Elsevier Inc. All rights reserved.

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