Lower limb amputation following venous cannulation for VA-ECMO: a case report
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SAGE Publications Ltd
Abstract
Lower limb amputation following arterial cannulation for VA-ECMO has been described in the literature. Limb ischemia however following venous cannulation is very rare and not quite understood. We present a case of limb ischemia following venous cannulation. A combination of venous congestion, compartment syndrome and subsequent arterial insufficiency is the proposed pathophysiology. Shock and use of vasopressors are compounding factors. Limb ischemia can be transient and reversible if diagnosed immediately and treated by early removal of the cannula. Our patient was unstable and ECMO dependent, and removal of the cannula was not an option. This resulted in limb loss and eventual above knee amputation. Use of the smallest appropriate venous cannula and early fasciotomy, in addition to hemodynamic optimization are measures that could help in preventing major amputation. © The Author(s) 2021.
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Amputation, Compartment syndrome, Ecmo, Ischemia, Venous gangrene, Amputation, surgical, Catheterization, peripheral, Extracorporeal membrane oxygenation, Femoral artery, Humans, Lower extremity, Retrospective studies, Risk factors, Digoxin, Epinephrine, Heparin, Hypertensive factor, Levothyroxine, Noradrenalin, Vitamin k group, Adult, Anticoagulation, Article, Atrial fibrillation, Body mass, Cannulation, Cardiogenic shock, Cardiomyopathy, Case report, Clinical article, Creatine kinase blood level, Fasciotomy, Heart failure, Hemodialysis, Human, Interstitial pneumonia, Knee amputation, Leg amputation, Limb ischemia, Male, Middle aged, Multiple organ failure, Sepsis, Veno-arterial ecmo, Venous congestion, Adverse event, Catheterization, Extracorporeal oxygenation, Lower limb, Procedures, Retrospective study, Risk factor