TY - JOUR
T1 - Ankle-brachial index to monitor limb perfusion in patients with femoral venoarterial extracorporeal membrane oxygenation
AU - Son, Andre Y.
AU - Karim, Azad S.
AU - Joung, Rachel Hae Soo
AU - McGregor, Randy
AU - Wu, Tingqing
AU - Andrei, Adin Cristian
AU - Pawale, Amit
AU - Ho, Karen J.
AU - Pham, Duc Thinh
N1 - Publisher Copyright:
© 2021 Wiley Periodicals LLC
PY - 2021/9
Y1 - 2021/9
N2 - Background: Limb ischemia is a major complication of femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO). Use of ankle-brachial index (ABI) to monitor limb perfusion in VA-ECMO has not been described. We report our experience monitoring femoral VA-ECMO patients with serial ABI and the relationships between ABI and near infrared spectroscopy (NIRS). Methods: This is a retrospective single-center review of consecutive adult patients placed on femoral VA-ECMO between January 2019 and October 2019. Data were collected on patients with paired ABI and NIRS values. Relationships between NIRS and ABI of the cannulated (E-NIRS and E-ABI) and non-cannulated legs (N-NIRS and N-ABI) along with the difference between legs (d-NIRS and d-ABI) were determined using Pearson correlation. Results: Overall, 22 patients (mean age 56.5 ± 14.0 years, 72.7% male) were assessed with 295 E-ABI and E-NIRS measurements, and 273 N-ABI and N-NIRS measurements. Mean duration of ECMO support was 129.8 ± 78.3 h. ECMO-mortality was 13.6% and in-hospital mortality was 45.5%. N-ABI and N-NIRS were significantly higher than their ECMO counterparts (ABI mean difference 0.16, 95% confidence interval [CI]: 0.13–0.19, p <.0001; NIRS mean difference 2.51, 95% CI: 1.48–3.54, p <.0001). There was no correlation between E-ABI versus E-NIRS (r =.032, p =.59), N-ABI versus N-NIRS (r =.097, p =.11), or d-NIRS versus d-ABI (r =.11, p =.069). Conclusion: ABI is a quantitative metric that may be used to monitor limb perfusion and supplement clinical exams to identify limb ischemia in femorally cannulated VA-ECMO patients. More studies are needed to characterize the significance of ABI in femoral VA-ECMO and its value in identifying limb ischemia in this patient population.
AB - Background: Limb ischemia is a major complication of femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO). Use of ankle-brachial index (ABI) to monitor limb perfusion in VA-ECMO has not been described. We report our experience monitoring femoral VA-ECMO patients with serial ABI and the relationships between ABI and near infrared spectroscopy (NIRS). Methods: This is a retrospective single-center review of consecutive adult patients placed on femoral VA-ECMO between January 2019 and October 2019. Data were collected on patients with paired ABI and NIRS values. Relationships between NIRS and ABI of the cannulated (E-NIRS and E-ABI) and non-cannulated legs (N-NIRS and N-ABI) along with the difference between legs (d-NIRS and d-ABI) were determined using Pearson correlation. Results: Overall, 22 patients (mean age 56.5 ± 14.0 years, 72.7% male) were assessed with 295 E-ABI and E-NIRS measurements, and 273 N-ABI and N-NIRS measurements. Mean duration of ECMO support was 129.8 ± 78.3 h. ECMO-mortality was 13.6% and in-hospital mortality was 45.5%. N-ABI and N-NIRS were significantly higher than their ECMO counterparts (ABI mean difference 0.16, 95% confidence interval [CI]: 0.13–0.19, p <.0001; NIRS mean difference 2.51, 95% CI: 1.48–3.54, p <.0001). There was no correlation between E-ABI versus E-NIRS (r =.032, p =.59), N-ABI versus N-NIRS (r =.097, p =.11), or d-NIRS versus d-ABI (r =.11, p =.069). Conclusion: ABI is a quantitative metric that may be used to monitor limb perfusion and supplement clinical exams to identify limb ischemia in femorally cannulated VA-ECMO patients. More studies are needed to characterize the significance of ABI in femoral VA-ECMO and its value in identifying limb ischemia in this patient population.
KW - cardiovascular research
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U2 - 10.1111/jocs.15757
DO - 10.1111/jocs.15757
M3 - Article
C2 - 34155679
AN - SCOPUS:85108283569
SN - 0886-0440
VL - 36
SP - 3119
EP - 3125
JO - Journal of Cardiac Surgery
JF - Journal of Cardiac Surgery
IS - 9
ER -