Contemporary practices and limb outcomes in peripheral venoarterial extracorporeal membrane oxygenation at a high-volume single institution.

Abstract

To evaluate the evolution of peripheral venoarterial extracorporeal membrane oxygenation access and the impact of adjuncts such as ultrasound guided access, distal perfusion catheters, and decannulation use on vascular complications, involvement, and outcome. A retrospective chart review of patients cannulated for peripheral venoarterial extracorporeal membrane oxygenation was performed at a large tertiary center using patients identified from a prospectively maintained extracorporeal life support registry. The primary end point was limb ischemia requiring fasciotomy or amputation. Secondary outcomes included limb ischemia, femoral pseudoaneurysm, artery dissection, hematoma, groin wound complication, and lymph leak. Of the patients in the extracorporeal life support registry from 2017 to 2024, 447 patients met inclusion criteria for this study. The mean age of the patients at the time of cannulation was 54.8 ± 15.1 years, 28.8% of the patients were female, and the body mass index was 29.5 ± 6.8. Indication for placement on venoarterial extracorporeal membrane oxygenation was most commonly cardiogenic shock (59.4%) and cardiac arrest (39.8%). The median duration of extracorporeal membrane oxygenation support was 4 [1, 7] days, with 50.7% of patients surviving decannulation. Of the entire cohort (N = 447), 8 (1.8%) patients experienced amputation (4 of 447, 0.9%) or fasciotomy (7 of 447, 1.5%). Also, 91 of 447 (20.3%) patients experienced secondary vascular complications. On multivariate analysis, peripheral artery disease was a risk factor for vascular complication (odds ratio, 2.19; 95% confidence interval, 1.34-3.59; P < .01). The overall primary and secondary vascular outcomes were not significantly different between the distal perfusion catheter and nondistal perfusion catheter groups or between the early group (2017-2022) and contemporary group (2023-2024). There was, however, a significant increase in ultrasound guidance use (73% vs 88%, P < .01), distal perfusion placement (81.3% vs 90%, P = .02), and Fogarty balloon use at decannulation (26% vs 65%), and a significant decrease in limb ischemia (8.2% vs 3.5%, P = .049) in the contemporary time period. This study presents a granular single-institution analysis of peripheral venoarterial extracorporeal membrane oxygenation cannulation practices and associated lower extremity vascular outcomes over an 8-year period. A significant reduction in limb ischemia in the contemporary cohort may reflect adaptations in practice patterns, with increased use of adjuncts such as ultrasound guidance, distal perfusion catheters, and Fogarty balloon thrombectomy at decannulation.