Strategies to reduce limb ischemia in peripheral venoarterial extracorporeal membrane oxygenation: A systematic review and Meta-analysis.

Autor: Marbach JA; Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center and Tufts University School of Medicine, United States of America; CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, United States of America; The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, United States of America., Faugno AJ; Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center and Tufts University School of Medicine, United States of America; The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, United States of America., Pacifici S; Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, United States of America., Chweich H; Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center and Tufts University School of Medicine, United States of America; The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, United States of America., Marbach JK; Department of Nursing, Tufts Medical Center, United States of America., Rabinowitz JB; Hirsh Health Sciences Library, Tufts University, United States of America., Thayer KL; The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, United States of America., Di Santo P; CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, United States of America., Kapur NK; Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, United States of America; The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, United States of America. Electronic address: NKapur@tuftsmedicalcenter.org.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2022 Aug 15; Vol. 361, pp. 77-84. Date of Electronic Publication: 2022 May 09.
DOI: 10.1016/j.ijcard.2022.04.084
Abstrakt: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides cardiovascular and respiratory support for patients in cardiogenic shock; yet, complications are a frequent source of morbidity and mortality. Limb ischemia can be potentially mitigated by limp perfusion protection strategies (LPPS). We performed a systematic review and meta-analysis to evaluate the safety and efficacy of two LPPS in patients treated with peripheral VA-ECMO - prophylactic insertion of a distal perfusion catheter (DPC) and small bore (<17 Fr) arterial return cannula. Among 22 included studies, limb ischemia was reduced in patients receiving a small arterial cannula (OR 0.40, 95% CI 0.24-0.65; p < 0.001) and in patients receiving a prophylactic DPC (OR 0.31, 95% CI 0.21-0.47; p < 0.001). Mortality was not significantly reduced with either a small arterial cannula (OR 0.70, 95% CI 0.23-2.18; p = 0.54) or prophylactic DPC strategy (OR 0.89, 95% CI 0.67-1.17; p = 0.40). As such, prophylactic insertion of a DPC or smaller bore arterial return cannula appear to reduce the risk of lower limb ischemia in this analysis. Further data are needed to confirm these findings. Registration: Registered in PROSPERO Database (Registration CRD42020215677).
(Copyright © 2022 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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