VESS21 - Arterial Limb Complications of Femoral Veno-Arterial Extra-Corporeal Life Support in Adult and Pediatric Populations

Objectives: Arterial limb complications (ALC), such as cannulation site bleeding requiring intervention, ipsilateral limb ischemia, compartment syndrome, and amputation, are common in femoral veno-arterial extracorporeal life support (VA-ECLS). We sought to describe VA-ECLS practices and evaluate risk of ALC in our adult and pediatric populations.

Methods: We examined all adult and pediatric femoral VA-ECLS patients between January 2010 and June 2022 at separate adult and pediatric hospitals to compare characteristics associated with ALC development in these two populations. Covariates include demographic and medical history, VA-ECLS cannulation configuration and techniques, scope, and management of VA-ECLS related complications. Our primary aim was to compare factors associated with ALC in adult and pediatric patients.

Results: Among 285 adults, the median age was 53[17-84], 60.7% were male, and 42.1% were White. Among 43 pediatric patients, the median age was 14[7-18], 55.8% male and 44.2% were White. The event rate for ALC was similar in both groups (adults: 28.8%, n=82; pediatrics: 30.2%, n=13, p=0.84). Limb ischemia was the most common type of ALC in both adults and pediatric groups, major amputations were uncommon in both groups (Table 1).
DPCs were placed in 210 (73.6%) adults and 30 (69.7%) pediatric patients (p=0.59) and were most often placed at the time of VA-ECLS initiation in both the adults and pediatric groups (66% vs 62.7%, p=0.68). Median arterial cannula size was 18Fr vs 19Fr in adults and pediatric patients, respectively. Venous cannulas were less likely to be placed in the same limb as the arterial cannula in the adult group vs pediatric group (58.6% vs 86.3%, p=0.004). Although Cardiothoracic Surgery is the primary service involved in cannulation and decannulation in both groups, Vascular Surgery was consulted due to concern for ALC in 36.5% of adult patients and 4.7% of pediatric patients, p=.001. While DPC placement at initiation of VA-ECLS was associated with a decreased risk of subsequent ALC (OR: 0.1; 95% CI, 0.02-0.4), this was not the case in the adult population (OR: 1.6; 95% CI, 0.8-3.0) (Table 2).

Conclusions: ALC in femoral VA-ECLS is common in both adult and pediatric cohorts. However, risk factors that are associated with ALC development after VA-ECLS in adult patients are not the same as those factors associated with ALC in the pediatric population. Further work is needed to clearly delineate practice patterns and technical factors that may help mitigate the risk of ALC after VA-ECLS initiation.