What Factors Are Associated With Arterial Line–Related Limb Ischemia in Patients on Extracorporeal Membrane Oxygenation? A Single-Center Retrospective Cohort Study
The primary purpose of this study was to identify factors associated with the development of arterial line–related limb ischemia in patients on extracorporeal membrane oxygenation (ECMO). The authors also sought to characterize and report the outcomes of patients who developed arterial line–related...
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| Published in | Journal of cardiothoracic and vascular anesthesia Vol. 37; no. 12; pp. 2489 - 2498 |
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| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Elsevier Inc
01.12.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1053-0770 1532-8422 1532-8422 |
| DOI | 10.1053/j.jvca.2023.08.131 |
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| Abstract | The primary purpose of this study was to identify factors associated with the development of arterial line–related limb ischemia in patients on extracorporeal membrane oxygenation (ECMO). The authors also sought to characterize and report the outcomes of patients who developed arterial line–related limb ischemia.
Retrospective cohort study.
A single academic tertiary referral ECMO center.
Consecutive patients who were treated with ECMO over 6 years.
Use of arterial line.
A total of 278 consecutive ECMO patients were included, with 19 (7%) patients developing arterial line–related limb ischemia during the ECMO run. Postcannulation Sequential Organ Failure Assessment (SOFA) (adjusted odds ratio [aOR] 1.20, 95% CI 1.08-1.32), Acute Physiology and Chronic Health Evaluation–II (aOR 0.84, 95% CI 0.74-0.95), and adjusted Vasopressor Dose Equivalence (aOR 1.03, 95% CI 1.01-1.05) scores were independently associated with the development of arterial line–associated limb ischemia. A SOFA score of ≥17 at the time of ECMO cannulation had an 80% sensitivity and 87% specificity for predicting arterial line–related limb ischemia.
Arterial line–related limb ischemia is much more common in ECMO patients than in the typical intensive care unit setting. The SOFA score may be useful in identifying which patients may be at risk for arterial line–related limb ischemia. As this was a single-center retrospective study, these results are inherently exploratory, and prospective multicenter studies are necessary to validate these results. |
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| AbstractList | The primary purpose of this study was to identify factors associated with the development of arterial line–related limb ischemia in patients on extracorporeal membrane oxygenation (ECMO). The authors also sought to characterize and report the outcomes of patients who developed arterial line–related limb ischemia.
Retrospective cohort study.
A single academic tertiary referral ECMO center.
Consecutive patients who were treated with ECMO over 6 years.
Use of arterial line.
A total of 278 consecutive ECMO patients were included, with 19 (7%) patients developing arterial line–related limb ischemia during the ECMO run. Postcannulation Sequential Organ Failure Assessment (SOFA) (adjusted odds ratio [aOR] 1.20, 95% CI 1.08-1.32), Acute Physiology and Chronic Health Evaluation–II (aOR 0.84, 95% CI 0.74-0.95), and adjusted Vasopressor Dose Equivalence (aOR 1.03, 95% CI 1.01-1.05) scores were independently associated with the development of arterial line–associated limb ischemia. A SOFA score of ≥17 at the time of ECMO cannulation had an 80% sensitivity and 87% specificity for predicting arterial line–related limb ischemia.
Arterial line–related limb ischemia is much more common in ECMO patients than in the typical intensive care unit setting. The SOFA score may be useful in identifying which patients may be at risk for arterial line–related limb ischemia. As this was a single-center retrospective study, these results are inherently exploratory, and prospective multicenter studies are necessary to validate these results. The primary purpose of this study was to identify factors associated with the development of arterial line-related limb ischemia in patients on extracorporeal membrane oxygenation (ECMO). The authors also sought to characterize and report the outcomes of patients who developed arterial line-related limb ischemia.OBJECTIVESThe primary purpose of this study was to identify factors associated with the development of arterial line-related limb ischemia in patients on extracorporeal membrane oxygenation (ECMO). The authors also sought to characterize and report the outcomes of patients who developed arterial line-related limb ischemia.Retrospective cohort study.DESIGNRetrospective cohort study.A single academic tertiary referral ECMO center.SETTINGA single academic tertiary referral ECMO center.Consecutive patients who were treated with ECMO over 6 years.PARTICIPANTSConsecutive patients who were treated with ECMO over 6 years.Use of arterial line.INTERVENTIONSUse of arterial line.A total of 278 consecutive ECMO patients were included, with 19 (7%) patients developing arterial line-related limb ischemia during the ECMO run. Postcannulation Sequential Organ Failure Assessment (SOFA) (adjusted odds ratio [aOR] 1.20, 95% CI 1.08-1.32), Acute Physiology and Chronic Health Evaluation-II (aOR 0.84, 95% CI 0.74-0.95), and adjusted Vasopressor Dose Equivalence (aOR 1.03, 95% CI 1.01-1.05) scores were independently associated with the development of arterial line-associated limb ischemia. A SOFA score of ≥17 at the time of ECMO cannulation had an 80% sensitivity and 87% specificity for predicting arterial line-related limb ischemia.MEASUREMENTS AND MAIN RESULTSA total of 278 consecutive ECMO patients were included, with 19 (7%) patients developing arterial line-related limb ischemia during the ECMO run. Postcannulation Sequential Organ Failure Assessment (SOFA) (adjusted odds ratio [aOR] 1.20, 95% CI 1.08-1.32), Acute Physiology and Chronic Health Evaluation-II (aOR 0.84, 95% CI 0.74-0.95), and adjusted Vasopressor Dose Equivalence (aOR 1.03, 95% CI 1.01-1.05) scores were independently associated with the development of arterial line-associated limb ischemia. A SOFA score of ≥17 at the time of ECMO cannulation had an 80% sensitivity and 87% specificity for predicting arterial line-related limb ischemia.Arterial line-related limb ischemia is much more common in ECMO patients than in the typical intensive care unit setting. The SOFA score may be useful in identifying which patients may be at risk for arterial line-related limb ischemia. As this was a single-center retrospective study, these results are inherently exploratory, and prospective multicenter studies are necessary to validate these results.CONCLUSIONSArterial line-related limb ischemia is much more common in ECMO patients than in the typical intensive care unit setting. The SOFA score may be useful in identifying which patients may be at risk for arterial line-related limb ischemia. As this was a single-center retrospective study, these results are inherently exploratory, and prospective multicenter studies are necessary to validate these results. |
| Author | Shu, Henry T. Cho, Sung-Min Yang, Victor B. Kim, Bo Soo Kagabo, Whitney Shah, Manuj M. Kalra, Andrew LaPorte, Dawn M. Muquit, Siam T. Covarrubias, Oscar Shou, Benjamin L. Whitman, Glenn Shafiq, Babar Zhao, Xiyu |
| Author_xml | – sequence: 1 givenname: Henry T. surname: Shu fullname: Shu, Henry T. email: Hshu5@jhmi.edu organization: Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD – sequence: 2 givenname: Oscar orcidid: 0000-0001-6382-0944 surname: Covarrubias fullname: Covarrubias, Oscar organization: Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD – sequence: 3 givenname: Manuj M. orcidid: 0000-0002-7374-2246 surname: Shah fullname: Shah, Manuj M. organization: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD – sequence: 4 givenname: Siam T. orcidid: 0009-0009-8730-3437 surname: Muquit fullname: Muquit, Siam T. organization: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD – sequence: 5 givenname: Victor B. orcidid: 0000-0002-4869-609X surname: Yang fullname: Yang, Victor B. organization: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD – sequence: 6 givenname: Xiyu orcidid: 0000-0002-7468-8456 surname: Zhao fullname: Zhao, Xiyu organization: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD – sequence: 7 givenname: Whitney surname: Kagabo fullname: Kagabo, Whitney organization: Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD – sequence: 8 givenname: Benjamin L. orcidid: 0000-0003-2825-3301 surname: Shou fullname: Shou, Benjamin L. organization: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD – sequence: 9 givenname: Andrew orcidid: 0000-0001-8338-019X surname: Kalra fullname: Kalra, Andrew organization: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD – sequence: 10 givenname: Glenn surname: Whitman fullname: Whitman, Glenn organization: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD – sequence: 11 givenname: Bo Soo surname: Kim fullname: Kim, Bo Soo organization: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD – sequence: 12 givenname: Sung-Min surname: Cho fullname: Cho, Sung-Min organization: Division of Neuroscience Critical Care, Departments of Neurology and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD – sequence: 13 givenname: Dawn M. surname: LaPorte fullname: LaPorte, Dawn M. organization: Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD – sequence: 14 givenname: Babar surname: Shafiq fullname: Shafiq, Babar organization: Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD |
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| SubjectTerms | arterial line extracorporeal membrane oxygenation finger ischemia gangrene limb ischemia |
| Title | What Factors Are Associated With Arterial Line–Related Limb Ischemia in Patients on Extracorporeal Membrane Oxygenation? A Single-Center Retrospective Cohort Study |
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