Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation (ECMO) support

Objective: Extracorporeal membrane oxygenation (ECMO) is a well-established treatment for severe cardiopulmonary failure. Due to the necessity of vascular access, patients undergoing ECMO-support are at risk of vascular complications (VC). Aim of this study was to review such complications in order to increase understanding of ECMO access techniques and outline basic technical principles.

Methods: From 01/2005 to 12/2009, 180 patients underwent ECMO-support through cannulation of femoral vessels. Primary outcome were all observed VC. Secondary outcomes were 30-day mortality and one-year survival. A logistic regression analysis identified predictors of VC.

Results: Arterial-venous mode was performed in 143 patients (78%) and veno-venous in 37 patients (22%). Arterial access was established percutaneously in 136 patients (95%) and by vessel exposure in 7 patients (5%). In 142 of cases (99%) requiring arterial access, an antegrade perfusion catheter was placed in femoral artery. Of the 17 observed VC (9%), 15 (88%) occurred in patients with arterial-venous access, whereas 2 (12%) occurred after veno-venous access. Two patients developing extremity ischemia, required limb amputation. Thirty-day mortality was 61% and 1-year survival rates were 28%. Peripheral vascular disease was a strong predictor of VC (OR: 7.19, 95%CI: 1.88 to 27.42, P=0.003), whereas implantation technique (open versus percutaneous) and ECMO duration were not. VC did not appear to be risk factors for early- or late mortality.

Conclusions: The incidence of VC through femoral cannulation was low but still considerable. Open vascular exposure or alternative vascular access sites should be preferred in patients with pre-existing peripheral arterial occlusive disease.