Evolution of distal limb perfusion management in adult peripheral venoarterial extracorporeal membrane oxygenation with femoral artery cannulation

Simons J, Mees B, MacLaren G, Fraser JF, Zaaqoq AM, Cho SM, Patel BM, Brodie D, Bělohlávek J, Belliato M, Jung JS, Salazar L, Meani P, Mariani S, Di Mauro M, Yannopoulos D, Broman LM, Chen YS, Riera J, van Mook WN, Lorusso R. Perfusion DOI 10.1177/02676591241236650

Abstract: Limb ischaemia is a clinically relevant complication of venoarterial extracorporeal membrane oxygenation (VA ECMO) with femoral artery cannulation. No selective distal perfusion or other advanced techniques were used in the past to maintain adequate distal limb perfusion. A more recent trend is the shift from the reactive or emergency management to the pro-active or prophylactic placement of a distal perfusion cannula to avoid or reduce limb ischaemia-related complications. Multiple alternative cannulation techniques to the distal perfusion cannula have been developed to maintain distal limb perfusion, including end-to-side grafting, external or endovascular femoro-femoral bypass, retrograde limb perfusion (e.g., via the posterior tibial, dorsalis pedis or anterior tibial artery), and, more recently, use of a bidirectional cannula.