Transient limb ischaemia during extracorporeal membrane oxygenation: inappropriate venous cannula location

Percutaneous placement of extracorporeal membrane oxygenation (ECMO) cannulas has many benefits. However, limb ischaemia still remains as an unresolved problem. We experienced an interesting case of limb ischaemia that was caused by external compression of the superficial femoral artery by the venous cannula. A 73-year old woman underwent veno-arterial ECMO due to sudden cardiac arrest with percutaneous femoral cannulations at the right common femoral vein and the left common femoral artery. Three hours after cannulation, the patient's right lower extremity was cool and pale, and the arterial pulses of dorsalis pedis artery and posterior tibial artery were not palpable. After confirming the absence of blood flow at the peripheral arteries of the lower extremity through colour Doppler ultrasonography, we explored the right femoral cannulation area. The venous cannula, which was approaching the common femoral vein from the lateral side, was passing between the bifurcation area of the superficial and deep femoral arteries, directly compressing the superficial femoral artery from beneath. We rapidly removed the inappropriately placed venous cannula, and then re-inserted it at another location of the femoral vein. Although it was an unusual case where arterial occlusion was due to external compression of the venous cannula, successful limb reperfusion could be obtained through rapid identification and correction.