Arterial access complications in patients with extracorporeal membrane oxygenation – literature review
DOI:
https://doi.org/10.48750/acv.570Keywords:
Extracorporeal membrane oxygenation, Mortality, Peripheral Artery DiseaseAbstract
INTRODUCTION: The use of extracorporeal membrane oxygenation (ECMO) has been increasing in recent years. Veno-Arterial ECMO (ECMO-VA) is usually deployed in refractory cardiac failure and is mostly cannulated through the common femoral artery. When present, arterial access complications may have important consequences in these patients. Therefore, this work aims to narratively review the available evidence regarding the impact of arterial access complications in patients undergoing ECMO-VA.METHODS: A Medline search was performed to identify articles focused on arterial access complications in patients undergoing ECMO-VA since 2010. The keywords were “extracorporeal membrane oxygenation,” “arterial access,” and “complications.” The primary endpoints were the description of the arterial complication with demographic characteristics and the short- and long-term prognosis.
RESULTS: The incidence of vascular complications in patients undergoing ECMO-VA ranges from 9.4% to 43.9%. In the majority of retrospective studies, their presence isn’t associated with increased mortality. However, in a meta-analysis, there was an increased mortality in patients with complications (RR 1.36; CI 95% 1.15-1.60; P=0.0004). The main risk factors are peripheral artery disease and female sex, while the reduced case volume can be associated with increased complications.
CONCLUSION: Most available evidence on managing arterial complications associated with ECMO derives from retrospective studies. To decrease the risk of access complications, protocols for cannulation, surveillance, and decannulation should be elaborated. Prospective studies are needed to improve the prevention and management of vascular access complications in patients under ECMO-VA.
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Lamb KM, DiMuzio PJ, Johnson A, Batista P, Moudgill N, McCullough M, et al. Arterial protocol including prophylactic distal perfusion catheter decreases limb ischemia complications in patients undergoing extracorporeal membrane oxygenation. J Vasc Surg. 2017;65:1074-9.
Kaufeld T, Beckmann E, Ius F, Koigeldiev N, Sommer W, Mashaqi B, et al. Risk factors for critical limb ischemia in patients undergoing femoral cannulation for venoarterial extracorporeal membrane oxygenation: Is distal limb perfusion a mandatory approach? Perfusion. 2019;34:453-9.
Ohira S, Kawamura M, Ahern K, Cavarocchi N, Hirose H. Aggressive placement of distal limb perfusion catheter in venoarterial extracorporeal membrane oxygenation. Int J Artif Organs. 2020;43:796-802.
Schad CA, Fallon BP, Monteagudo J, Okochi S, Cheung EW, Morrissey NJ, et al. Routine Use of Distal Arterial Perfusion in Pediatric Femoral Venoarterial Extracorporeal Membrane Oxygenation. Artif Organs. 2017;41:11-6.
Mohite PN, Fatullayev J, Maunz O, Kaul S, Sabashnikov A, Weymann A, et al. Distal limb perfusion: Achilles' heel in peripheral venoarterial extracorporeal membrane oxygenation. Artif Organs. 2014;38:940-4.
Xu X, Liu Z, Han P, He M, Xu Y, Yin L, et al. Feasibility and safety of total percutaneous closure of femoral arterial access sites after veno-arterial extracorporeal membrane oxygenation. Medicine (Baltimore). 2019;98:e17910.
Hayakawa N, Tobita K, Kodera S, Koyama E, Miyashitata H, Sahashi S, et al. Efficacy and Safety of Percutaneous Venoarterial Extracorporeal Membrane Oxygenation Decannulation Using Endovascular Balloon Dilation and Perclose ProGlide Closure Device: Results from the Multicenter SKYLINE Study. Ann Vasc Surg. 2023;96:357-64
Martin-Tuffreau AS, Bagate F, Boukantar M, Saiydoun G, Mangiameli A, Rostain L, et al. Complete percutaneous angio-guided approach using preclosing for venoarterial extracorporeal membrane oxygenation implantation and explantation in patients with refractory cardiogenic shock or cardiac arrest. Crit Care. 2021;25:93.
Hwang JW, Yang JH, Sung K, Song YB, Hahn JY, Choi JH, et al. Percutaneous removal using Perclose ProGlide closure devices versus surgical removal for weaning after percutaneous cannulation for venoarterial extracorporeal membrane oxygenation. J Vasc Surg. 2016;63:998-1003
Chandel A, Desai M, Ryan LP, Clevenger L, Speir AM, Singh R. Preclosure technique versus arterial cutdown after percutaneous cannulation for venoarterial extracorporeal membrane oxygenation. JTCVS Tech. 2021;10:322-30.
Liu Z, Xu Y, Xu X, He M, Han P, Shao C, et al. Comparison of Success Rate and Complications of Totally Percutaneous Decannulation in Patients With Veno-Arterial Extracorporeal Membrane Oxygenation and Endovascular Aneurysm Repair. Front Med (Lausanne). 2021;8:724427.
Bemtgen X, Heidt T, Zotzmann V, Rilinger J, Wengenmayer T, Biever PM, et al. Venoarterial extracorporeal membrane oxygenation decannulation using the novel Manta vascular closure device. Eur Heart J Acute Cardiovasc Care. 2020;9:342-7.
Silverberg D, Hater H, Halak M. Rise in Percutaneous Vascular Procedures and Extracorporeal Membrane Oxygenation Is Associated With Increase in Emergent Vascular Operations. Vasc Endovascular Surg. 2023;57:53-9.
Bisdas T, Beutel G, Warnecke G, Hoeper MM, Kuehn C, Haverich A, et al. Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support. Ann Thorac Surg. 2011;92:626-31.
Yeo HJ, Kim HJ, Jang JH, Kang LH, Cho WH, Kim D. Vascular Complications Arising from Hemostasis with Manual Compression Following Extracorporeal Membrane Oxygenation Decannulation. J Card Surg. 2016;31:123-6.
Augusto R, Passos Silva M, Campos J, Coelho A, Coelho N, Semião AC, et al. Arterial Vascular Complications in Peripheral Venoarterial Extracorporeal Membrane Oxygenation Support. Rev Port Cir Cardiotorac Vasc. 2019;26:45-50.
Singh V, Singh G, Arya RC, Kapoor S, Garg A, Ralhan S, et al. Vascular access complications in patients undergoing veno-arterial ecmo and their impact on survival in patients with refractory cardiogenic shock: A retrospective 8-year study. Ann Card Anaesth. 2022;25:171-7.
Schaefer AK, Distelmaier K, Riebandt J, Goliasch G, Bernardi MH, Zimpfer D, et al. Access site complications of postcardiotomy extracorporeal life support. J Thorac Cardiovasc Surg. 2022;164:1546-58
Wong JK, Melvin AL, Joshi DJ, Lee CY, Archibald WJ, Angona RE, et al. Cannulation-Related Complications on Veno-Arterial Extracorporeal Membrane Oxygenation: Prevalence and Effect on Mortality. Artif Organs. 2017;41:827-34.
Gulkarov I, Khusid E, Worku B, Demissie S, Guerges M, Salemi A, et al. Meta-Analysis of the Effect of Vascular Complications on Mortality in Patients Undergoing Femoral Venoarterial Extracorporeal Membrane Oxygenation. Ann Vasc Surg. 2021;71:488-95.
Lemor A, Dabbagh MF, Cohen D, Villablanca P, Tehrani B, Alaswad K, et al. Rates and impact of vascular complications in mechanical circulatory support. Catheter Cardiovasc Interv. 2022;99:1702-11.
Wilhelm MJ, Inderbitzin DT, Malorgio A, Aser R, Gülmez G, Aigner T, et al. Acute limb ischemia after femoro-femoral extracorporeal life support implantation: A comparison of surgical, percutaneous, or combined vascular access in 402 patients. Artif Organs. 2022;46:2284-92.
Becher PM, Goßling A, Schrage B, Twerenbold R, Fluschnik N, Seiffert M, et al. Procedural volume and outcomes in patients undergoing VA-ECMO support. Crit Care. 2020;24:291.
Lamb KM, Hirose H. Vascular Complications in Extracoporeal Membrane Oxygenation. Crit Care Clin. 2017;33:813-24.
