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Evolution of distal limb perfusion management in adult peripheral venoarterial extracorporeal membrane oxygenation with femoral artery cannulation

. 2024 Apr ; 39 (1_suppl) : 23S-38S.

Language English Country England, Great Britain Media print

Document type Journal Article, Review

Limb ischaemia is a clinically relevant complication of venoarterial extracorporeal membrane oxygenation (VA ECMO) with femoral artery cannulation. No selective distal perfusion or other advanced techniques were used in the past to maintain adequate distal limb perfusion. A more recent trend is the shift from the reactive or emergency management to the pro-active or prophylactic placement of a distal perfusion cannula to avoid or reduce limb ischaemia-related complications. Multiple alternative cannulation techniques to the distal perfusion cannula have been developed to maintain distal limb perfusion, including end-to-side grafting, external or endovascular femoro-femoral bypass, retrograde limb perfusion (e.g., via the posterior tibial, dorsalis pedis or anterior tibial artery), and, more recently, use of a bidirectional cannula. Venous congestion has also been recognized as a potential contributing factor to limb ischaemia development and specific techniques have been described with facilitated venous drainage or bilateral cannulation being the most recent, to reduce or avoid venous stasis as a contributor to impaired limb perfusion. Advances in monitoring techniques, such as near-infrared spectroscopy and duplex ultrasound analysis, have been applied to improve decision-making regarding both the monitoring and management of limb ischaemia. This narrative review describes the evolution of techniques used for distal limb perfusion during peripheral VA ECMO.

2nd Department of Medicine Department of Cardiovascular Medicine General University Hospital Prague Prague Czech Republic

Academy for Postgraduate Medical Training Maastricht University Medical Center Maastricht The Netherlands

Cardiothoracic Intensive Care Unit National University Health System Singapore

Cardiovascular Research Institute Maastricht Maastricht University Maastricht The Netherlands

Center for Resuscitation Medicine University of Minnesota Medical School Minneapolis MN USA

Critical Care Research Group The Prince Charles Hospital University of Queensland Brisbane QLD Australia

Department de Medicina Intensiva Vall d'Hebron Institut de Recerca SODIR Hospital Universitari Vall d'Hebron Barcelona Spain

Department of Anesthesiology Division of Critical Care University of Virginia Charlottesville VA USA

Department of Cardio Thoracic Surgery CARIM School for Cardiovascular Diseases Heart and Vascular Center Maastricht University Medical Center Maastricht The Netherlands

Department of Critical Care Mayo Clinic Arizona Scottsdale AZ USA

Department of Intensive Care Fundación Cardiovascular de Colombia Bucaramanga Colombia

Department of Intensive Care Medicine Maastricht University Medical Center Maastricht The Netherlands

Department of Pediatric Perioperative Medicine and Intensive Care ECMO Centre Karolinska Karolinska University Hospital Stockholm Sweden

Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden

Department of Surgery National Taiwan University Hospital Taipei Taiwan

Department of Thoracic and Cardiovascular Surgery Korea University Medicine Seoul Republic of Korea

Department of Vascular Surgery CARIM School for Cardiovascular Diseases Heart and Vascular Center Maastricht University Medical Center Maastricht The Netherlands

Division of Neuroscience Critical Care Department of Anesthesiology and Critical Care Medicine School of Medicine Johns Hopkins University Baltimore MD USA

Division of Neuroscience Critical Care Department of Neurology School of Medicine Johns Hopkins University Baltimore MD USA

Division of Pulmonary and Critical Care Medicine Department of Medicine School of Medicine The Johns Hopkins Hospital Baltimore MD USA

S Gerardo Hospital is the hospital of the departmen Monza Italy

SC AR 2 Anestesia e Terapia Intensiva Cardiotoracica Foundation IRCCS Policlinico San Matteo Pavia Italy

School of Health Professions Education Maastricht University Maastricht The Netherlands

References provided by Crossref.org

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