From the Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Perfusion Services, Duke University Medical Center, Durham, North Carolina.
ASAIO J. 2018 May/Jun;64(3):328-333. doi: 10.1097/MAT.0000000000000656.
Femoral arterial cannulation in adult venoarterial (VA) extracorporeal membrane oxygenation (ECMO) predisposes patients to ipsilateral limb ischemia. Placement of a distal perfusion catheter (DPC) is one of few techniques available to prevent or manage this complication. Although frequently used, the indications for and timing of DPC placement are poorly characterized, and no guidelines are available to guide its use. The purpose of this study was to compare the incidences of vascular complications and limb ischemia between patients who did and did not receive a DPC at the time of primary ECMO cannulation. Between June 2009 and April 2015, 132 adults underwent VA ECMO cannulation at our institution. Of the 80 femoral cannulations comprising this retrospective single-center study cohort, 14 (17.5%) received a DPC at the time of primary cannulation. Demographics, indications for ECMO, and cardiovascular history and risk factors were not significantly different between comparison groups. Median arterial cannula size was 17 French in both groups. Vascular complications occurred in 2 of the 14 patients with initial DPC (14.3%) compared with 21 of 66 without initial DPC (31.8%; p = 0.188). Limb ischemia occurred in 2 of 14 patients in the DPC group (14.3%) and 15 of 66 in the non-DPC group (22.7%; p = 0.483). In-hospital mortality was comparable between groups. DPC placement at the time of primary cannulation may lower the incidence of limb ischemia. The benefit of DPC placement once evidence of limb ischemia is apparent remains unclear.
成人静脉-动脉（VA）体外膜肺氧合（ECMO）中股动脉插管使患者易发生同侧肢体缺血。放置远端灌注导管（DPC）是预防或处理这种并发症的少数几种技术之一。尽管经常使用，但 DPC 放置的适应证和时机描述较差，并且没有指南可指导其使用。本研究的目的是比较初次 ECMO 插管时是否放置 DPC 的患者血管并发症和肢体缺血的发生率。2009 年 6 月至 2015 年 4 月，我院 132 例成人接受 VA ECMO 插管。在这项回顾性单中心研究队列中，80 例股动脉插管中有 14 例（17.5%）在初次插管时放置了 DPC。比较组之间的人口统计学、ECMO 适应证以及心血管病史和危险因素无显著差异。两组的动脉插管中位数均为 17 French。初次放置 DPC 的 14 例患者中有 2 例（14.3%）发生血管并发症，而初次未放置 DPC 的 66 例患者中有 21 例（31.8%）发生血管并发症（p = 0.188）。DPC 组有 2 例（14.3%）患者发生肢体缺血，非 DPC 组有 15 例（22.7%）患者发生肢体缺血（p = 0.483）。两组院内死亡率相当。初次插管时放置 DPC 可能会降低肢体缺血的发生率。一旦出现肢体缺血的证据，放置 DPC 的益处尚不清楚。
