• Henry T Shu, Oscar Covarrubias, Manuj M Shah, Siam T Muquit, Victor B Yang, Xiyu Zhao, Whitney Kagabo, Benjamin L Shou, Andrew Kalra, Glenn Whitman, Bo Soo Kim, Sung-Min Cho, Dawn M LaPorte, Babar Shafiq, and Hopkins Education, Research, and Advancement in Life Support Devices Group.
• Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: Hshu5@jhmi.edu.
• J. Cardiothorac. Vasc. Anesth. 2023 Dec 1; 37 (12): 248924982489-2498.

ObjectivesThe primary purpose of this study was to identify factors associated with the development of arterial line-related limb ischemia in patients on extracorporeal membrane oxygenation (ECMO). The authors also sought to characterize and report the outcomes of patients who developed arterial line-related limb ischemia.DesignRetrospective cohort study.SettingA single academic tertiary referral ECMO center.ParticipantsConsecutive patients who were treated with ECMO over 6 years.InterventionsUse of arterial line.Measurements And Main ResultsA total of 278 consecutive ECMO patients were included, with 19 (7%) patients developing arterial line-related limb ischemia during the ECMO run. Postcannulation Sequential Organ Failure Assessment (SOFA) (adjusted odds ratio [aOR] 1.20, 95% CI 1.08-1.32), Acute Physiology and Chronic Health Evaluation-II (aOR 0.84, 95% CI 0.74-0.95), and adjusted Vasopressor Dose Equivalence (aOR 1.03, 95% CI 1.01-1.05) scores were independently associated with the development of arterial line-associated limb ischemia. A SOFA score of ≥17 at the time of ECMO cannulation had an 80% sensitivity and 87% specificity for predicting arterial line-related limb ischemia.ConclusionsArterial line-related limb ischemia is much more common in ECMO patients than in the typical intensive care unit setting. The SOFA score may be useful in identifying which patients may be at risk for arterial line-related limb ischemia. As this was a single-center retrospective study, these results are inherently exploratory, and prospective multicenter studies are necessary to validate these results.Copyright © 2023 Elsevier Inc. All rights reserved.

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