{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:18:23Z","timestamp":1787649503649,"version":"build-2736575974"},"reference-count":13,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Femoro-femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is associated with limb ischemic complications. Routine near-infrared spectroscopy (NIRS) monitoring and a more standardized distal perfusion strategy were introduced at our institution in 2016. We compared ischemia-related interventions, amputations, and early mortality between the treatment eras. Methods: Consecutive patients undergoing femoro-femoral VA-ECMO from 2012 to 2024 were analyzed retrospectively and stratified by VA-ECMO initiation before 2016 or from 2016 onward. The primary endpoint was a peripheral ischemic vascular complication requiring surgical or interventional therapy; an inclusive sensitivity definition additionally incorporated four clinically plausible but less certain events. Period-specific rates were estimated using Poisson regression adjusted for baseline distal perfusion cannula (DPC) status and extracorporeal cardiopulmonary resuscitation (eCPR). Results: The analytic cohort comprised 270 patients (45 pre-2016 and 225 post-2016). The primary endpoint occurred in 50 patients (18.5%, 95% confidence interval (CI) 14.1\u201323.7): 3\/45 (6.7%, 95% CI 1.4\u201318.3) before 2016 and 47\/225 (20.9%, 95% CI 15.8\u201326.8) thereafter. Adjusted rates were 4.6% (95% CI 1.0\u201320.5) and 18.9% (95% CI 13.6\u201326.3), with an adjusted risk ratio of 4.11 (95% CI 1.06\u201317.93). The inclusive sensitivity analysis yielded similar estimates (adjusted risk ratio 3.31, 95% CI 1.05\u201311.47). Five patients underwent lower-limb amputation (1\/45 pre-2016 and 4\/225 post-2016). Kaplan\u2013Meier 30-day mortality estimates were 56.8% overall (95% CI 50.8\u201362.9), 58.9% pre-2016 (95% CI 44.9\u201373.5), and 56.4% post-2016 (95% CI 49.9\u201363.1). Conclusions: Ischemia-related interventions were more frequently recorded after 2016, while amputations remained rare and 30-day mortality was similar. Because monitoring, DPC practice, and other aspects of care changed concurrently, and NIRS was used without a standardized trigger algorithm, the reasons for the observed era difference cannot be determined. The findings are exploratory and do not establish causal effects of NIRS or DPC use.<\/jats:p>","DOI":"10.3390\/jcm15176546","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:00:48Z","timestamp":1787644848000},"page":"6546","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Limb Ischemia-Related Interventions and 30-Day Mortality After Femoro-Femoral VA-ECMO: A Pre\/Post Implementation-Era Comparison"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8226-6149","authenticated-orcid":false,"given":"Robert","family":"Zilberszac","sequence":"first","affiliation":[{"name":"Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8010-7665","authenticated-orcid":false,"given":"Andreas","family":"Gleiss","sequence":"additional","affiliation":[{"name":"Institute of Clinical Biometrics, Center for Medical Data Science, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Richter","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9268-2461","authenticated-orcid":false,"given":"Anne-Kristin","family":"Sch\u00e4fer","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8601-9989","authenticated-orcid":false,"given":"Julia","family":"Riebandt","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6874-5349","authenticated-orcid":false,"given":"Patrick","family":"Haider","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5324-6336","authenticated-orcid":false,"given":"Thomas M.","family":"Hofbauer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3539-994X","authenticated-orcid":false,"given":"Max","family":"Lenz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Gelbenegger","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yalong","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"N\u00f6stlinger","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8284-2994","authenticated-orcid":false,"given":"Christian","family":"Hengstenberg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gottfried","family":"Heinz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7267-3138","authenticated-orcid":false,"given":"Walter S.","family":"Speidl","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.jacc.2018.11.038","article-title":"Venoarterial ECMO for Adults","volume":"73","author":"Guglin","year":"2019","journal-title":"J. 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Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.amjcard.2023.07.149","article-title":"Association of Prophylactic Distal Perfusion Cannulation with Mortality in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation","volume":"207","author":"Lee","year":"2023","journal-title":"Am. J. 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Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1016\/j.jvs.2025.09.062","article-title":"Contemporary Practices and Limb Outcomes in Peripheral Venoarterial Extracorporeal Membrane Oxygenation at a High-Volume Single Institution","volume":"83","author":"Matthews","year":"2026","journal-title":"J. Vasc. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6546\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:18:40Z","timestamp":1787645920000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6546"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":13,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176546"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176546","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]}}}