VESS21 - The Impact of Distal Perfusion Catheters on Vascular Complications in VA ECMO at a Single institution

Objectives: Current guidelines on the use and timing of distal perfusion catheters (DPCs) remain inconsistent and poorly characterized. In the largest cohort of patients undergoing peripheral veno-arterial extracorporeal membrane oxygenation (VA ECMO) reported to date, we evaluate the impact of DPCs on lower extremity vascular complications and limb loss.

Methods: We conducted a single institution retrospective chart review of patients who underwent peripheral VA ECMO cannulation for cardiogenic shock or cardiac arrest. Patients were grouped into those who received a DPC and those who did not. The primary endpoint was limb ischemia requiring fasciotomy or amputation. Secondary outcomes were defined as acute limb ischemia, pseudoaneurysm, artery dissection, hematoma, seroma and lymphocele following cannulation as documented in assessment of progress notes or in operative reports by a surgical team. A groin wound problem was counted if it required operative debridement or plastic surgery coverage. P-values were calculated with Wilcoxon rank sum and Chi-Squared test.

Results: Of the 934 patients identified in the ECLS registry from 2017 to 2024, 447 patients met inclusion criteria. Of these, 84.8% (379/447) had a DPC. Of those patients with a DPC, 92.1% of these were placed at time of ECMO cannulation. BMI at time of cannulation was lower in the DPC group (29.0 +/- 6.5 vs 31.6 +/- 8, P-Value 0.012). Female patients were less likely to have a DPC. (44.0% (30/68) vs 26.3% (99/379). (Table 1) Cardiac arrest prior to cannulation was more prevalent in the non DPC group (53.1% vs 33.4%, p = 0.002). (Table 1) There was no difference in primary outcome of limb ischemia requiring fasciotomy or amputation between the two groups, 2.5% (9/379) of DPC patients and 2.9% (2/68) of non-DPC patients (p = 0.781). Also, there was no significant difference in secondary vascular complications; 20.8% (79/379) of DPC vs 13.2% (9/68) of non DPC patients (p = 0.282). (Table 2)

Conclusions: There was no significant difference in severe limb ischemia rates or secondary vascular complications between patients who underwent peripheral VA-ECMO cannulation with or without a distal perfusion catheter. Both groups had lower rates of amputation and fasciotomy than currently published data. Further investigation to define potentially confounding patient, anatomic, technical and institutional characteristics are needed.