Limited data are available regarding prevention of limb ischemia in femorally cannulated patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). We investigated the association between strategy of distal perfusion catheter (DPC) insertion and vascular complications like limb ischemia in patients undergoing VA-ECMO.

We evaluated 230 patients from two tertiary hospitals who received VA-ECMO via femoral cannulation between August 2014 and July 2017. The patients were divided into two groups according to DPC insertion strategy: patients who underwent DPC insertion at the time of primary cannulation (DPC group, n  = 96) and patients who were provisionally treated with DPC (No-DPC group, n  = 134). The primary outcome was limb ischemia.

Of the 96 patients in the DPC group, 61 (63.5%) underwent insertion under fluoroscopic guidance. The DPC group had a significantly lower incidence of limb ischemia (2.1% vs. 8.2%, p  = 0.047) and a lower tendency of in-hospital mortality (38.5% vs. 50.7%, p  = 0.067) than the No-DPC group. In the multivariable analysis, fluoroscopy-guided simultaneous insertion of the DPC (odds ratio 0.11; 95% confidence interval 0.01–0.98; p  = 0.048) was a significant predictor of reduction of limb ischemia.

Simultaneous insertion of a DPC, particularly under fluoroscopy guidance, can be considered as a preventive strategy for limb ischemia in femorally cannulated patients on VA-ECMO.