Leg reperfusion technique and ischemia diagnosis using ultrasound in patients treated with extracorporeal life support for refractory cardiac arrest - 16/01/25
, G. Sergey 2, K. Marinos 2, M. Alexandra 2, D. Jaeger 3, B. Dannielle 4, B. Megarbane 1, B. Jason 2, D. Yannopoulos 2Résumé |
Introduction |
Leg ischemia after extracorporeal life support (ECLS) for refractory cardiac arrest (CA) may be prevented by effective leg reperfusion.
Objective |
We aimed to describe: (1) the prevalence of cannulated leg ischemia; (2) the distal perfusion catheter (DPC) technique and its improvements over time; (3) the blood flow velocities by ultrasound doppler associated with cannulated leg ischemia.
Method |
Retrospective single-centre study including patients≥18 years old receiving ECLS under cardiopulmonary resuscitation (CPR) by our team between December 2015 and October 2023. The Institutional Review Board of our institution approved the study. Data is expressed as frequencies (percentages), medians (interquartile range 25–75), and compared using Fisher's exact and Mann-Whitney tests. Logistic regression was performed to determine technical improvements associated with absence of ischemia. Blood flow velocity cutoffs associated with cannulated leg ischemia were determined according to receiver operator characteristics curves.
Results |
Three hundred and thirty-eight patients were included, 60 (50–66) years old, 96% with shockable initial rhythm. Time interval from CPR to ECLS was 60 (50–72) min. Survival to discharge was 24%. A DPC was successfully inserted in 94% of the patients, under ultrasound guidance using Amplatz stiff wires – initial technique (IT). The IT was improved resulting in the present technique (PT) by continuously perfusing heparin in the DPC, using>12cm-long sheaths for overweight patients, and routinely using braided sheaths to avoid kinking. Cannulated leg ischemia occurred in 10/77(13%) with IT and 13/261 (5%) with PT, P=0.014. Braided sheaths use was associated with absence of ischemia, odds ratio 0.18, 95% confidence interval (0.045–0.65), P=0.001. Blood flow velocity associated with ischemia was 17cm/s in the mid-superficial femoral artery, and 12 to 6cm/s in the rest of the arteries (Figure 1).
Conclusion |
Using the present distal perfusion technique of the cannulated leg, ischemia prevalence was 5%. Braided catheters were associated with absence of leg ischemia. Blood flow velocities thresholds associated with cannulated leg ischemia ranged between 17 and 6cm/s.
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Vol 118 - N° 1S
P. S150 - janvier 2025 Retour au numéro
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