Research Fellow Louisville, Kentucky, United States
Disclosure(s):
Joshua G. Crane, MD: No financial relationships to disclose
Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains a mainstay rescue therapy for cardiogenic shock. Femoral VA-ECMO places the lower extremities at risk for acute limb ischemia (ALI), increasing in-hospital mortality risk. Currently, there is limited monitoring technology for ALI. We present 2 VA-ECMO patients with the MYO1 continuous compartment pressure monitoring.
Methods: Following femoral cannulation for VA-ECMO, consent was obtained for the placement of the MYO1 continuous compartment pressure monitors.. After the devices were calibrated, one device was placed sterilely into each anterior tibial compartment under ultrasound guidance to avoid neurovascular structures and ensure placement within the fascial compartment. The Bluetooth enabled devices then were monitored via the MY01 application on tablets within the patient room. The devices detect a pressure and temperature each second and providers can monitor for trends in pressure and temperature change.
Outcome: Patient 1 is a 45-year-old female suffered a cardiac arrest and was cannulated with a 19F right femoral arterial cannula and a 25F right femoral venous cannula and transferred to our tertiary center. MY01 devices were placed. The right leg device showed an elevation in pressure that continued to rise over 30mmHg, marking risk of compartment syndrome (Figure 1). At this time, the right sided arterial cannula and distal perfusion catheter (DPC) were removed. A new 15F arterial cannula and 5F DPC were placed in the right femoral artery and superficial femoral artery (SFA), respectively. Flow was restored and the compartment pressures returned to physiologic pressures. Patient 2 is a 50-year-old male that was cannulated for VA-ECMO after PEA arrest with a 15F left femoral arterial cannula and a 25F right femoral venous cannula. MY01 devices were placed. There was pulselessness and mottling in the left lower extremity and a 9F DPC was placed. During routine care, the DPC was dislodged and temperature of the distal limb began to drop below physiologic levels and pressure began to rise (Figure 1). Following replacement of the DPC and confirmation of return of distal limb flow, compartment temperature returned to physiologic levels.
Conclusion: Acute limb ischemia in VA-ECMO patients increases risk of in-hospital mortality. The MY01 Continuous Compartment Pressure Monitors allows providers to assess trends in pressure and temperature to assist in clinical decision-making regarding ALI in VA-ECMO patients.
