Ischemia-related vascular complications of percutaneously initiated venoarterial extracorporeal membrane oxygenation: Indication setting, risk factors, manifestation and outcome.

PURPOSE: Venoarterial (VA) ECMO is widely accepted as salvage therapy for cardio-respiratory or cardiac failure. Vascular complications from cannulation are common and potentially life-threatening. Here, we retrospectively analyzed vascular complications following VA ECMO therapy.

MATERIAL AND METHODS: Patients treated with VA ECMO via femoral cannulation from 2010 to 2016 were enrolled. Patient factors, indication and procedure were retrieved from our hospital database and statistically analyzed.

RESULTS: 223 patients were enrolled. Survival rate was 43, 0%. Ischemic vascular complications were seen in 43, 9%. Main manifestation (82, 7%) was stenosis or occlusion of the femoral (common and superficial) or the external iliacal artery. Embolus or dissection occurred in 4, 1%. 32, 7% patients with ischemia required surgical intervention with 24,5% suffering from compartment syndrome. An antegrade perfusion catheter was established in 50% of the patients. Patients receiving VA ECMO for extracorporeal cardiopulmonary resuscitation had the lowest ischemic rates with 28,6%. Multiple regression analysis identified only the underlying indication and the size of the cannula as significant risk factor for vascular complications. Survival rates to hospital discharge were 37,3% and 47,2% in patients with and without ischemic complications.

CONCLUSIONS: Cannula size and indication setting are the most important factors for the development of ischemic complications following VA ECMO.