3, 12, 17
Decide about distal limb perfusion at the time of cannulation, not after ischaemia appears, and monitor the limb on every round.
No distal perfusion cannula
DOI 10.1177/02676591241236650
Distal perfusion cannula and other distal limb perfusion strategies
Review of observational data; the pooled DPC effect comes from non-randomised studies with confounding by indication. No randomised comparison of prophylactic versus reactive DPC exists.
Limb ischaemia occurs in 10-30% of peripheral femoral VA ECMO patients (historically up to 70% without preventive technique). A summarised meta-analysis found DPC reduced limb ischaemia from 25.4% to 9.7%, absolute risk reduction 15.7%, risk ratio 0.41 (p<0.01); in one series 3.4% with DPC versus 21.4% without required intervention for critical limb ischaemia. Guidance is prophylactic DPC at ECMO initiation in all patients. Technique: short 6-8 Fr armoured cannula, target flow about 100 mL/min, antegrade femoral/superficial femoral or retrograde posterior tibial. Monitoring: NIRS above 50% and preferably 60% with bilateral difference under 20%; duplex ultrasound as adjunct; clinical examination limited in sedated patients.
Adults on peripheral femoral VA ECMO