Near-Infrared Spectroscopy for Preventing Limb Ischemia in Extracorporeal Membrane Oxygenation

Limb ischemia is a serious complication of venoarterial (VA) extracorporeal membrane oxygenation (ECMO), potentially resulting in amputation, rhabdomyolysis, or death. This study aimed to evaluate the effectiveness of near-infrared spectroscopy (NIRS) monitoring in the early detection and prevention of limb ischemia in peripheral VA ECMO.

We retrospectively reviewed 166 patients who underwent peripheral VA ECMO between January 2018 and December 2022. Patients were categorized into two groups based on the implementation of NIRS monitoring (Before-NIRS [n = 83] vs. After-NIRS [n = 83]). An inverse probability of treatment weighting (IPTW)-adjusted analysis was conducted.

Baseline characteristics were not significantly different between the groups. The ECMO weaning success rate was significantly higher in the After-NIRS group (45.9% vs. 63.4%, p = 0.026). However, survival to discharge did not differ significantly (31.8% vs. 42.7%, p = 0.174). The incidences of rhabdomyolysis and acute limb ischemia were significantly lower in the After-NIRS group (10.6% vs. 1.2% and 11.8% vs. 0%, respectively). In the After-NIRS group, a decrease in NIRS values was observed in three patients, prompting timely placement of distal perfusion catheters. None of these patients developed limb ischemia.

After the implementation of NIRS monitoring, no cases of limb ischemia were observed. NIRS enables early identification of limb malperfusion, facilitates timely intervention, and reduces unnecessary distal perfusion catheter placement. As a non-invasive, real-time monitoring modality, NIRS offers continuous assessment of limb perfusion and plays a valuable role in the early prevention of limb ischemia in patients undergoing peripheral VA ECMO.