{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:02:49Z","timestamp":1777874569473,"version":"3.51.4"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>While potential risks for limb ischemia have been explored in studies of venoarterial extracorporeal membrane oxygenation (ECMO), they remain inadequately defined for patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). We identified risk factors for the development of lower limb ischemia during ECPR using a large nationwide ECPR cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A post hoc analysis was conducted using a nationwide, multicenter, retrospective study (Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan II [SAVE-J II]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Thirty-six institutions from 2013 to 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>Adult patients who underwent ECPR for out-of-hospital cardiac arrest.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions:<\/jats:title>\n                    <jats:p>None.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results:<\/jats:title>\n                    <jats:p>\n                      Lower limb ischemia was defined as the requirement for a therapeutic distal perfusion catheter (DPC), fasciotomy, or amputation. Risk factors for lower limb ischemia were assessed using multivariate logistic regression models that included patient characteristics, ECPR-related information, and resuscitation content as potential confounders. Of the 969 patients, 72 (7.4%) developed lower limb ischemia. No significant differences were observed regarding background characteristics, cannulation location, puncture method, or venoarterial ECMO catheter size between patients with and without limb ischemia. However, a prophylactic DPC was less frequently employed in patients with lower limb ischemia than in those without (4 [5.6%] vs. 219 [24.4%];\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). Higher incidences of cannulation-related bleeding and cannula malposition were observed in patients with limb ischemia than in those in patients without limb ischemia (22 [30.6%] vs. 162 [18.1%];\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.009 and 9 [12.5%] vs. 29 [3.2%];\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001, respectively). Multivariable analyses revealed that prophylactic DPC placement was associated with a lower risk of limb ischemia (0.20 [0.07\u20130.55];\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.002), whereas cannulation-related bleeding and cannula malposition were linked to an increased risk of lower limb ischemia (1.83 [1.06\u20133.14];\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.030 and 3.81 [1.68\u20138.64];\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.001, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Lower limb ischemia during ECPR would be anticipated in patients with cannulation-related complications, and prophylactic DPC placement may be considered to mitigate the risk of lower limb ischemia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/ccm.0000000000007010","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T15:00:34Z","timestamp":1767106834000},"page":"484-495","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Risk of Developing Lower Limb Ischemia in Patients With Extracorporeal Cardiopulmonary Resuscitation: A Secondary Analysis of the Study of Advanced Cardiac Life Support for Ventricular Fibrillation With Extracorporeal Circulation in Japan II (SAVE-J II) Study"],"prefix":"10.1097","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9367-1636","authenticated-orcid":false,"given":"Kazuki","family":"Matsumura","sequence":"first","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryo","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daiki","family":"Kaito","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichiro","family":"Homma","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akihiko","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toru","family":"Hifumi","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, St. Luke\u2019s International Hospital, Tokyo, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetsuya","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhiro","family":"Kuroda","sequence":"additional","affiliation":[{"name":"Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junichi","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan II (SAVE-J II) study group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"R1-20260430","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/S0140-6736(18)30472-0","article-title":"Out-of-hospital cardiac arrest: Current concepts.","volume":"391","author":"Myat","year":"2018","journal-title":"Lancet"},{"key":"R2-20260430","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1001\/jama.2019.1696","article-title":"In-hospital cardiac arrest: A 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