Introduction: Percutaneous cannulation of femoral vessels has been widely used for rapid deployment of extracorporeal life support (ECLS). Limb ischemia is a devastating complication in patients receiving ECLS.
Hypothesis: Our aim was to evaluate the predictors of limb ischemia during ECLS and role of preventive distal perfusion.
Methods: A total of 255 consecutive patients who received veno-arterial ECLS due to cardiac and/or respiratory failure were enrolled from January 2009 to December 2015, with the exclusion of 8 patients receiving ECLS for less than 6 hours, and their data was reviewed retrospectively. Preventive or therapeutic distal perfusion to minimize lower limb ischemia depended on physician discretion. Predictors for lower limb ischemia during ECLS were analyzed using multivariate regression analysis.
Results: Among the 255 patients, the mean age was 58 and 177 (69.4%) were male. Limb ischemia developed in 24 patients (9.4 %). 178 patients (69.8 %) expired within 30 days. Among the 24 patients with limb ischemia, distal perfusion was performed in 1 patient (4.2%) preventively and in 14 patients (58.3%) therapeutically. After distal perfusion, 2 patients (8.3%) still needed surgical intervention. Limb ischemia was frequent in patients with female (54.2% with in ischemia group versus 28.1% in non-ischemia group, p = 0.008) and shorter in height (161.98±9.45 cm in the ischemia group versus 166.32±9.08 cm in the non-ischemia group, p = 0.027). Patients with height less than 165 cm were higher in ischemia group rather than those with over 165 cm (79.2% versus 40.7%, p < 0.001). In a multivariate regression analysis, female sex (hazard ratio (HR)[95% confidence interval (CI)] = 3.018[1.287-7.080], p = 0.011) was the only predictor for limb ischemia.
Conclusions: Smaller female patients are more prone to develop limb ischemia from femoral ECLS. Our findings might support preventive distal perfusion and more careful observation for these patients.