Ankle-brachial index to monitor limb perfusion in patients with femoral venoarterial extracorporeal membrane oxygenation

Andre Y. Son, Azad S. Karim, Rachel Hae Soo Joung, Randy McGregor, Tingqing Wu, Adin Cristian Andrei, Amit Pawale, Karen J. Ho, Duc Thinh Pham

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2 Scopus citations


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.

Original languageEnglish
Pages (from-to)3119-3125
Number of pages7
JournalJournal of cardiac surgery
Issue number9
StatePublished - Sep 2021


  • cardiovascular research


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