Limb ischemia
Major vascular complications are common in post-cardiotomy patients
after ECMO support mainly due to reduced blood flow which may occur due
to various factors such as large cannula (>20 Fr) occluding
the vessel, female gender, and peripheral vascular disease like
atherosclerosis. Limb amputation may also be necessary in severe and
lifesaving cases.
Reperfusion injuries may then occur when blood flow is increased, which
may result in rhabdomyolysis, acute kidney injury, multi-organ failure
and systemic inflammatory response . Insertion of cannula under
fluoroscopic guidance can help significantly reduce limb ischaemia.
Frequent monitoring of cannula site will also ensure cannula is not
kinked or obstructed by thrombus. A duplex ultrasound can be used to
detect blood flow however it is user-dependent and cannot be monitored
continuously. Flow monitoring through the ECMO shunt could be feasible
for continuous monitoring. Graft interposition can also be done to
eliminate limb ischemia.