Veno-arterial extracorporeal membrane oxygenation [VA ECMO] is a rescue therapy that has seen a significant increase in utilization over the past decade. Femoral cannulation is a common strategy used to deploy VA ECMO. There are many complications associated with femoral VA ECMO, including distal limb ischemia. Limb ischemia can lead to fasciotomies, infection, amputation, altered quality of life, and even death. Prevention and early identification of ischemia is key.
The goal of this paper was to investigate the efficacy of the utilization of distal perfusion catheters as a means of preventing limb ischemia. This was completed through an extensive literature review. The literature review was completed through PubMed using search terms such as “femoral veno-arterial ECMO”, and combining this with other key terms including “distal perfusion cannula”, “limb complications”, “limb ischemia”, and “prevention”. Exclusion criteria for articles included: cannulation other than femoral, studies including pediatric population, and non limb related complications.
Thirteen retrospective studies and one meta-analysis were included in this paper. The data gleaned from these studies were utilized to identify potential limb complications from peripheral cannulation, risk factors precluding a patient to limb ischemia, clinical indications and monitoring for limb ischemia, and techniques to prevent distal limb ischemia. Through the research conducted, it can be concluded that the early use of distal perfusion catheter is efficacious in preventing distal limb ischemia.
