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 - Funding Information:
The authors would like to acknowledge the nurses of our cardiothoracic intensive care unit for the vigilant care and attention they provide to the critically ill patients and their families.
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
UR - http://www.scopus.com/inward/record.url?scp=85108283569&partnerID=8YFLogxK
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 -