Does a distal perfusion cannula reduce ischaemic complications of extracorporeal membrane oxygenation ?

Background Extracorporeal membrane oxygenation ( ECMO ) provides support to patients with severe but reversible cardiac or pulmonary failure. Vascular complications of ECMO are well recognized. Methods We performed a retrospective review of 70 patients (mean age 48 years; 15–85) who received peripheral veno‐arterial ECMO from 2004 to 2010 in a single centre. For statistical analysis, c hi‐squared test and multivariate binary logistic regression analysis were used to assess for association between response variables (i.e. limb ischaemia, ECMO site bleeding and deep vein thrombosis ( DVT )) and possible predictive variables. Results There were 14 (20%) cases of acute limb ischaemia with no statistically significant relationship between acute limb ischaemia and independent variables. Thirty‐three patients received distal limb cannulas (47%). There was no statistically significant association between limb ischaemia and presence of distal limb cannula ( P  = 0.8). Multivariate binary logistic regression analysis identified insertion by cutdown as a predictor of lower probability of insertion site bleeding ( n  = 12, odds ratio 0.24, P  = 0.04). Seven cases of DVT were identified; multivariate binary logistic regression analysis identified insertion by cutdown (odds ratio 0.08, P  = 0.03) and days of ECMO less than five (odds ratio 0.08, P  = 0.04) as predictive factors for reduced rates of DVT . Conclusion Ischaemic complications of ECMO are common and occur despite the presence of a distal limb‐perfusing cannula; however in our study the distal limb cannula was a limb‐salvaging intervention in six patients. Prolonged time on ECMO is a risk factor for DVT , and a high index of suspicion must be maintained. Percutaneous insertion was associated with higher rates of bleeding and DVT .