Vascular Complications in Extracorporeal Membrane Oxygenation—A Narrative Review
Abstract
:1. Introduction
2. Anatomy
3. Pathophysiology
3.1. Bio-Injury in ECMO
3.2. Acute Arterial Thrombosis
3.3. Acute Arterial Embolism
3.4. Compartment Syndrome
3.5. Acute Venous Thrombosis
3.6. Acute Venous Thromboembolism
3.7. Iatrogenic Injuries
4. Vascular Complications
4.1. Predisposing Factors
4.2. Access
4.3. Arterial Events
4.4. Venous Events
5. Treatment Strategies
5.1. Ischemia Secondary to Arterial Obstruction
5.2. Ischemia Secondary to Arterial Embolism
5.3. Ischemia Secondary to Arterial Thrombosis
5.4. Venous Hypertension Due to Venous Obstruction
5.5. Ischemia Due to Venous Thrombosis
5.6. Compartment Syndrome
5.7. Major Amputation
6. Mitigation Strategies
6.1. Access Site Assessment
6.2. Ultrasound-Guided Access
6.3. Cannula Size
6.4. Distal Perfusion Catheter
6.5. Thrombus Prevention
6.6. Improving Venous Drainage
6.7. Monitoring
6.8. Re-Positioning or Revision of the Cannula Site
7. Outcomes
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
References
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Systemic | Arterial | Venous |
---|---|---|
Bio-injury | Acute Arterial thrombosis | Acute Venous Thrombosis |
Bleeding | Peri Cannula fibrin sheath and in situ thrombosis | Peri Cannula fibrin sheath and in situ thrombosis |
Infection | Acute Arterial embolism | Venous thrombo-embolism |
Multiorgan dysfunction | Malperfusion of the limb | Venous hypertension |
Compartment Syndrome | Compartment Syndrome | |
Iatrogenic Insertion Injury | Iatrogenic Insertion Injury | |
Iatrogenic Decannulation injury | Iatrogenic Decannulation injury |
ECMO Perspective | Salvageable | Salvageable | Potentially Salvageable | Non-Salvageable | |
---|---|---|---|---|---|
SVS Stage | I | IIa | IIb | III | |
Prognosis | Limb viable, not immediately threatened | Limb marginally threatened, salvageable with prompt revascularization | Limb immediately threatened, salvageable with immediate revascularization | Limb irreversibly damaged, major tissue loss or permanent nerve damage; revascularization is not appropriate | |
Findings | Sensory Loss | None | Minimal (toes) | More than toes, pain at rest | Profound, anesthetic |
Muscle Weakness | None | None | Mild or moderate | Paralysis (rigor) | |
Doppler Signal | Waveform | BiPhasic /Monophasic | Monophasic | Non | Non |
Arterial | Audible | Often inaudible | Inaudible | Inaudible | |
Venous | Audible | Audible | Audible | Inaudible | |
Duplex | Normal flow | Deceased Flow | Decreased to intermittent Flow | Absent Pflow | |
Angiography | Normal Opacification and Normal Flow | Normal Opacification but Slow Flow | Reduced to No Distal Opacification with Slow Flow | No Opacification and No flow |
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Hart, J.P.; Davies, M.G. Vascular Complications in Extracorporeal Membrane Oxygenation—A Narrative Review. J. Clin. Med. 2024, 13, 5170. https://doi.org/10.3390/jcm13175170
Hart JP, Davies MG. Vascular Complications in Extracorporeal Membrane Oxygenation—A Narrative Review. Journal of Clinical Medicine. 2024; 13(17):5170. https://doi.org/10.3390/jcm13175170
Chicago/Turabian StyleHart, Joseph P., and Mark G. Davies. 2024. "Vascular Complications in Extracorporeal Membrane Oxygenation—A Narrative Review" Journal of Clinical Medicine 13, no. 17: 5170. https://doi.org/10.3390/jcm13175170