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Ankle-brachial index to monitor limb perfusion in patients with femoral venoarterial extracorporeal membrane oxygenation
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  • Andre Son,
  • Azad Karim,
  • Rachel Joung,
  • Randy Mcgregor ,
  • Tingqing Wu,
  • Adin-Cristian Andrei,
  • Amit Pawale ,
  • Karen Ho,
  • Duc Pham
Andre Son
Northwestern University Feinberg School of Medicine

Corresponding Author:andre.son@northwestern.edu

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Azad Karim
Northwestern University Feinberg School of Medicine
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Rachel Joung
Northwestern University Feinberg School of Medicine
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Randy Mcgregor
Northwestern University Feinberg School of Medicine
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Tingqing Wu
Northwestern University Feinberg School of Medicine
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Adin-Cristian Andrei
Northwestern University Feinberg School of Medicine
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Amit Pawale
Northwestern University Feinberg School of Medicine
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Karen Ho
Northwestern University Feinberg School of Medicine
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Duc Pham
Northwestern University Feinberg School of Medicine
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Abstract

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 hours. 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%CI 0.13-0.19, p<0.0001; NIRS mean difference 2.51, 95%CI 1.48-3.54, p<0.0001). There was no correlation between E-ABI vs. E-NIRS (r=0.032, p=0.59), N-ABI vs. N-NIRS (r=0.097, p=0.11), or D-NIRS vs. D-ABI (r=0.11, p=0.069). Conclusions: 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.
02 Apr 2021Submitted to Journal of Cardiac Surgery
02 Apr 2021Submission Checks Completed
02 Apr 2021Assigned to Editor
22 Apr 2021Reviewer(s) Assigned
19 May 2021Editorial Decision: Accept
Sep 2021Published in Journal of Cardiac Surgery volume 36 issue 9 on pages 3119-3125. 10.1111/jocs.15757