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Lower limb amputation following venous cannulation for VA-ECMO: a case report
Natasha Habr1, Jamal J Hoballah2, Jamil Borgi3
1Division of Plastic and Reconstructive Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Limb ischemia after venous cannulation for VA-ECMO is rare. Prompt diagnosis and intervention are crucial for limb salvage, but ECMO dependence can necessitate amputation.
Area of Science:
- Cardiology
- Vascular Surgery
- Intensive Care Medicine
Background:
- Venous Cannulation for VA-ECMO: Extracorporeal membrane oxygenation (ECMO) is a life-support measure for severe cardiorespiratory failure.
- Lower limb amputation is a known complication of arterial cannulation for VA-ECMO.
- Limb ischemia following venous cannulation is exceptionally rare and poorly understood.
Observation:
- A case of limb ischemia following venous cannulation for VA-ECMO is presented.
- The patient experienced limb ischemia attributed to venous congestion, compartment syndrome, and subsequent arterial insufficiency.
- Shock and vasopressor use were identified as compounding factors.
Findings:
- Immediate diagnosis and cannula removal can lead to transient and reversible limb ischemia.
- In this case, ECMO dependence prevented cannula removal, leading to irreversible limb ischemia.
- The patient ultimately required an above-knee amputation.
Implications:
- Minimizing venous cannula size and performing early fasciotomy are potential preventive strategies.
- Hemodynamic optimization is critical in managing patients on VA-ECMO.
- This case highlights the importance of vigilance for rare complications of venous cannulation in VA-ECMO.
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