Novel cannulation strategy with a bidirectional cannula for distal limb perfusion during peripheral veno-arterial extracorporeal life support: A preliminary, single-centre study
| Autor: | Jorik Simons, Arne R Doddema, Erik PJ Körver, Michele di Mauro, Sandra Agricola, Jeroen Smets, Renske Metz, Silvia Mariani, Maria Elena De Piero, Matteo Matteucci, Jamie Romeo, Justine M. Ravaux, Walther NKA van Mook, Barend ME Mees, Roberto Lorusso |
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| Jazyk: | angličtina |
| Rok vydání: | 2023 |
| Předmět: |
Advanced and Specialized Nursing
bi-flow cannula VASCULAR COMPLICATIONS MEMBRANE-OXYGENATION General Medicine extracorporeal membrane oxygenation extracorporeal life support ISCHEMIA REFRACTORY CARDIAC-ARREST veno-arterial SURVIVAL SHOCK Radiology Nuclear Medicine and imaging livanova bidirectional FEMORAL CANNULATION LOWER-EXTREMITY Cardiology and Cardiovascular Medicine Safety Research ULTRASOUND ARTERY |
| Zdroj: | Perfusion. 38:44-53 |
| ISSN: | 1477-111X 0267-6591 |
| DOI: | 10.1177/02676591231159565 |
| Popis: | Introduction Limb ischemia is a severe complication of peripheral veno-arterial extracorporeal life support (V-A ECLS). Several techniques have been developed to prevent this, but it remains a major and frequent adverse event (incidence: 10–30%). In 2019, a new cannula with bidirectional flow (retrograde towards the heart and antegrade towards the distal limb) has been introduced. A single-centre experience with this cannula in patients undergoing peripheral V-A ECLS is herewith reported. Methods This prospective observational study included adults (≥18 years) undergoing V-A ECLS from January 2021 to October 2022 with the use of a bidirectional femoral artery cannula. Primary outcome was limb ischemia requiring intervention during cardio-circulatory support. Secondary outcomes were compartment syndrome, limb amputation, cannulation site bleeding, need for other surgical intervention due to cannula related complications, duplex ultrasound parameters from the femoral vessels, and in-hospital survival. Results Twenty-two consecutive patients were included. During extracorporeal life support (ECLS) support, limb ischemia requiring intervention occurred in one patient (4.5%) and no patients developed a compartment syndrome, or required a fasciotomy or amputation. Significant bleeding was reported in two patients (9%) due to slight cannula dislodgement, easily solved with cannula repositioning. In-hospital survival was 63.6%. Conclusions The bidirectional cannula is associated with a low risk for limb ischemia-related complications compared to current literature, and apparently represents a safe alternative to dedicated distal perfusion cannula. Further studies are warranted to confirm these preliminary findings. |
| Databáze: | OpenAIRE |
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