S. Chaurasia1, A. Vallakati3, M. Henn2, B. Whitson2, N. Mokadam2, D. Mast2, S. Satyapriya4, A. M. Ganapathi2 1Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA 2Ohio State University, Division Of Cardiac Surgery, Department Of Surgery, Columbus, OH, USA 3Ohio State University, Division Of Cardiovascular Diseases, Department Of Internal Medicine, Columbus, OH, USA 4Ohio State University, Department Of Anesthesiology, Columbus, OH, USA
Introduction: Prevention of limb ischemia in patients with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is primarily through use of distal perfusion catheters (DPC). Nearly all current descriptions of the benefits of DPC are through single institutional studies and prior pooled analyses have only focused on limb ischemia outcomes. We aimed to assess the role of the prophylactic placement of DPCs in reducing the incidence of limb ischemia, as well as the effect on mortality and bleeding, through the use of a pooled analysis.
Methods: A literature search was performed using PubMed, Scopus and Embase databases using the search terms ‘ECMO, Limb Ischemia’ and ‘ECMO, Distal Perfusion’. Studies were only included that compared ECMO with DPC versus ECMO without DPC. Studies with < 5 patients in either arms were excluded. A random effects model with Mantel–Haenszel method was used to analyze the data.
Results: Seventeen studies met criteria for analysis. Pooled analysis included a total of 2079 patients, of which 917 patients received ECMO with DPC and 1162 patients underwent ECMO without DPC. When compared to ECMO alone, ECMO with DPC significantly decreased limb ischemia (relative risk [RR] 0.50, 95% confidence interval [CI] 0.31-0.79; p=0.003; Figure A). No differences in mortality (RR 0.89, 95% CI 0.76-1.03; p=0.12; Figure B) and bleeding complications (RR 1.43, 95% CI 0.41-4.96; p=0.58; Figure C) were observed between the two groups.
Conclusion: Although the guidelines regarding the indication for the use of DPC are not well established, our analysis demonstrates that the placement of DPC is associated with a reduced risk of limb ischemia versus no DPC, but is not associated with mortality or bleeding complications. Further studies are necessary to help guide the placement and management of DPC to further minimize limb ischemic events.
