Femoral limb Ischemia and cerebral monitoring during VA ECMO Belavi Vishwanath KLE's Hospital and MRC, Nehru Nagar, Belagavi, Karnataka Online published on 7 December, 2019. Abstract Introduction Extracorporeal Membrane Oxygenation also commonly referred to as ECMO, is a form of extracorporeal life support by a modified heartlung machine that is potentially lifesaving in patients with cardio-respiratory failure. Its use was first described by Hill et al. in 1972, in the treatment of a young man with acute respiratory distress syndrome (ARDS) after a motor vehicle accident, 1 and has since been increasingly used to temporarily support patients with cardiac, respiratory or combined cardio-respiratory failure for a period of days to weeks. Traditionally the use of this form of support was reserved primarily for the pediatric population, especially in the treatment of neonatal respiratory failure, but its initial application in adults was limited. Early trials in adults were disappointing, with poor outcomes and no survival benefit being reported over conventional treatment.3, 4 However, with advancements in mechanical cardio-respiratory technology, such as the development and use of new and improved centrifugal pumps and oxygenators, 5–7 and increasing center experience in the management of these patients, outcomes for adults that are placed on this form of support are improving, and the use of ECMO in this population is increasing. Percutaneous femoral Venoarterial (VA) or jugular Veno-venous (VV) ECMO can result in delivery of hypoxic blood to the brain, coronaries and upper extremities. Additionally, VA-ECMO by percutaneous femoral artery cannulation may compromise perfusion to the lower limbs. Use of Near-Infrared Spectroscopy (NIRS) detects regional ischemia and warns of impending hypoxic damage. We report the first known series with standardized monitoring of this parameter in adults on ECMO. Methods & Results Twenty patients were analyzed (Median age: 47.5 years), 17 patients were placed on VA-ECMO, and 3 patients on VV-ECMO. The median duration on ECMO was 7 days (Range 2–26). 100% of patients had a significant drop in bilateral cerebral oximetry tracings resulting in hemodynamic interventions, which involved increasing pressure, oxygenation and/or ECMO ow. In 16 (80%) patients, interventions corrected the underlying ischemia. 4 (20%) patients required further diagnostic intervention for persistent decreased bilateral and/or unilateral cerebral oximetry tracings, and were found to have a cerebrovascular accident (CVA). Six (30%) patients had persistent unilateral lower limb oximetry events, which resolved uponplacement or replacement of a distal perfusion cannula. No patient was found to have either lower limb ischemia or a CVA with normal NIRS tracings. Conclusion Use of NIRS with ECMO is important in detecting ischemic peripheral vascular and cerebral events. This allows for potential correction of the underlying process, thus preventing permanent ischemic damage. Top Keywords Extracorporeal Membrane Oxygenation, Near-Infrared Spectroscopy, Ischemia, lower limb Cerebral Oximetry. Top |