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Capillary refill time and tissue oxygen saturation as factors influencing lower limb ischemia in VA-ECMO: a
Zhenjia Liu1, Lin Han1, Li Mo1
1Department of Critical Care Medicine, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
Background And Objectives:
Venous-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a pivotal means for rapid cardiopulmonary support, yet it may result in lower limb ischemia. This study aims to explore the high-risk factors for lower limb ischemia following VA-ECMO.
Methods:
117 patients who received VA-ECMO treatment at Guangxi Zhuang Autonomous Region People's Hospital from June 2022 to December 2023 were divided into lower limb ischemia group and non ischemia group for case-control analysis.
Results:
In this case-control study of 117 VA-ECMO patients, 22 (18.80%) experienced lower limb ischemia. Patients with ischemia had significantly lower body surface area (BSA) and lower tissue oxygen saturation (StO2) levels, but higher capillary refill time (CRT) levels compared to those without ischemia (P < 0.05). Spearman correlation analysis showed that StO2 and CRT had strong correlations with ischemia. Binary logistic stepwise regression analysis identified CRT and StO2 as independent risk factors for lower limb ischemia. Specifically, lower StO2 levels were associated with an increased risk of ischemia (OR = 0.615, P < 0.05), while higher CRT levels were also associated with an increased risk (OR = 27.571, P < 0.05). The Receiver Operating Characteristic (ROC) curve shows that the areas of CRT and StO2 are 0.924 (P < 0.001, 95% CI 0.866-0.983) and 0.951 (P = 0.023, 95% CI 0.906-0.997), respectively.
Conclusions:
StO2 reflects real-time tissue perfusion adequacy, whereas CRT serves as a marker of microvascular dysfunction. Lower StO2 levels (indicating impaired oxygenation) and higher CRT levels (suggesting delayed capillary refilling) were independently associated with an increased risk of lower limb ischemia, suggesting that monitoring these parameters may be useful in identifying patients at higher risk for this complication. These findings provide valuable insights for risk stratification and potential intervention strategies in the management of VA-ECMO patients.
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