{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:55:58Z","timestamp":1789088158341,"version":"build-2803163510"},"reference-count":48,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T00:00:00Z","timestamp":1675987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock is rising. Acute limb ischaemia remains one of the main complications after ECMO initiation. We analysed 104 patients from our databank from January 2015 to December 2021 who were supported with mobile ECMO therapy. We aimed to identify the impact of acute limb ischaemia on short-term outcomes in patients placed on ECMO in our institution. The main indication for ECMO therapy was left ventricular (LV) failure with cardiogenic shock (57.7%). Diameters of arterial cannulas (p = 0.365) showed no significant differences between both groups. Furthermore, concomitant intra-aortic balloon pump (IABP, p = 0.589) and Impella (p = 0.385) implantation did not differ significantly between both groups. Distal leg perfusion was established in approximately 70% of patients in two groups with no statistically significant difference (p = 0.960). Acute limb ischaemia occurred in 18.3% of cases (n = 19). In-hospital mortality was not significantly different (p = 0.799) in both groups. However, the bleeding rate was significantly higher (p = 0.005) in the limb ischaemia group compared to the no-limb ischaemia group. Therefore, early diagnosis and prevention of acute limb ischaemia might decrease haemorrhage complications in patients during ECMO therapy.<\/jats:p>","DOI":"10.3390\/life13020485","type":"journal-article","created":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T03:52:49Z","timestamp":1676001169000},"page":"485","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Acute Limb Ischaemia during ECMO Support: A 6-Year Experience"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0573-8218","authenticated-orcid":false,"given":"Ihor","family":"Krasivskyi","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Gro\u00dfmann","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marit","family":"Dechow","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5810-8626","authenticated-orcid":false,"given":"Ilija","family":"Djordjevic","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borko","family":"Ivanov","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart Centre, Helios Hospital Siegburg, 53721 Siegburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Gerfer","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walid","family":"Bennour","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elmar","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Sabashnikov","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3978-9251","authenticated-orcid":false,"given":"Parwis Baradaran","family":"Rahmanian","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navid","family":"Mader","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaveh","family":"Eghbalzadeh","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten","family":"Wahlers","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Mucka, S., Miodonska, M., Jakubiak, G.K., Starzak, M., Cieslar, G., and Stanek, A. (2022). Endothelial Function Assessment by Flow-Mediated Dilation Method: A Valuable Tool in the Evaluation of the Cardiovascular System. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191811242"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1038\/s41569-021-00607-3","article-title":"Epidemiology of cardiovascular disease in Europe","volume":"19","author":"Townsend","year":"2022","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Rajsic, S., Breitkopf, R., Oezpeker, U.C., and Treml, B. (2022). ECMO in Cardiogenic Shock: Time Course of Blood Biomarkers and Associated Mortality. Diagnostics, 12.","DOI":"10.3390\/diagnostics12122963"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1111\/jocs.14526","article-title":"Central vs peripheral venoarterial ECMO in postcardiotomy cardiogenic shock","volume":"35","author":"Djordjevic","year":"2020","journal-title":"J. Card. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3125","DOI":"10.1053\/j.jvca.2020.02.020","article-title":"Early Detection, Prevention, and Management of Acute Limb Ischemia in Adults Supported with Venoarterial Extracorporeal Membrane Oxygenation","volume":"34","author":"Chanan","year":"2020","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Alhijab, F.A., Tantawy, T.M., Ismail, H.H., AlBarrak, M., Adam, A.I., Belghith, M., Hassan, E., Pragliola, C., Albabtain, M.A., and Arafat, A.A. (2022). Venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock: The impact of cannulation strategy on survival. Perfusion, 2676591221114954.","DOI":"10.1177\/02676591221114954"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1053\/j.jvca.2022.09.086","article-title":"Popliteal Sciatic Nerve Block as Rescue Therapy in Acute Lower Limb Ischemia Related to Venoarterial ECMO Support","volume":"37","author":"Diop","year":"2023","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"938634","DOI":"10.3389\/fmed.2022.938634","article-title":"Limb Ischemia Complications of Veno-Arterial Extracorporeal Membrane Oxygenation","volume":"9","author":"Hu","year":"2022","journal-title":"Front. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1186\/s13054-019-2541-3","article-title":"Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: A narrative review of incidence, prevention, monitoring, and treatment","volume":"23","author":"Bonicolini","year":"2019","journal-title":"Crit. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/j.athoracsur.2013.09.008","article-title":"Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: A meta-analysis of 1866 adult patients","volume":"97","author":"Cheng","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1016\/j.athoracsur.2015.10.095","article-title":"The Impact of Vascular Complications on Survival of Patients on Venoarterial Extracorporeal Membrane Oxygenation","volume":"101","author":"Tanaka","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Chen, K.H., Chen, Y.T., Yeh, S.L., Weng, L.C., and Tsai, F.C. (2018). Changes in quality of life and health status in patients with extracorporeal life support: A prospective longitudinal study. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0196778"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1583\/09-2845.1","article-title":"A novel percutaneous solution to limb ischemia due to arterial occlusion from a femoral artery ECMO cannula","volume":"17","author":"Rao","year":"2010","journal-title":"J. Endovasc. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e1269","DOI":"10.1097\/CCM.0000000000004688","article-title":"Vascular Complications of Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Regression Analysis","volume":"48","author":"Jia","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/MAT.0000000000001344","article-title":"Extracorporeal Cardiopulmonary Resuscitation in Adults. Interim Guideline Consensus Statement from the Extracorporeal Life Support Organization","volume":"67","author":"Richardson","year":"2021","journal-title":"ASAIO J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1097\/MAT.0000000000001510","article-title":"ELSO Interim Guidelines for Venoarterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients","volume":"67","author":"Lorusso","year":"2021","journal-title":"Asaio J."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Krasivskyi, I., Ivanov, B., Vehrenberg, J., Eghbalzadeh, K., Gerfer, S., Gaisendrees, C., Kuhn, E., Sabashnikov, A., Mader, N., and Djordjevic, I. (2022). Sex-Related Differences in Short-Term Outcomes after Mobile VA-ECMO Implantation: Five-Year Experience of an ECMO Retrieval Program. Life, 12.","DOI":"10.3390\/life12111746"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1097\/MAT.0000000000001653","article-title":"Extracorporeal Life Support Organization Guideline for Transport and Retrieval of Adult and Pediatric Patients with ECMO Support","volume":"68","author":"Labib","year":"2022","journal-title":"ASAIO J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.jvs.2020.05.071","article-title":"Limb ischemia and bleeding in patients requiring venoarterial extracorporeal membrane oxygenation","volume":"73","author":"Son","year":"2021","journal-title":"J. Vasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.1016\/j.jtcvs.2015.11.044","article-title":"Lower-extremity complications with femoral extracorporeal life support","volume":"151","author":"Vallabhajosyula","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"692399","DOI":"10.3389\/fmed.2021.692399","article-title":"Double Distal Perfusion Catheters for Severe Limb Ischemia on the IABP Side in Patients Who Received Femoro-Femoral VA-ECMO with IABP","volume":"8","author":"Xin","year":"2021","journal-title":"Front. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E263","DOI":"10.1111\/aor.12942","article-title":"Efficacy of Distal Perfusion Cannulae in Preventing Limb Ischemia during Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis","volume":"41","author":"Juo","year":"2017","journal-title":"Artif. Organs"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1053\/j.jvca.2018.08.193","article-title":"Patient Demographics and Extracorporeal Membranous Oxygenation (ECMO)-Related Complications Associated with Survival to Discharge or 30-Day Survival in Adult Patients Receiving Venoarterial (VA) and Venovenous (VV) ECMO in a Quaternary Care Urban Center","volume":"33","author":"Kaushal","year":"2019","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.avsg.2019.06.012","article-title":"The Effect of Acute Limb Ischemia on Mortality in Patients Undergoing Femoral Venoarterial Extracorporeal Membrane Oxygenation","volume":"62","author":"Gulkarov","year":"2020","journal-title":"Ann. Vasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"489","DOI":"10.2217\/fca.13.34","article-title":"Arterial vascular complications in peripheral extracorporeal membrane oxygenation support: A review of techniques and outcomes","volume":"9","author":"Roussel","year":"2013","journal-title":"Future Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1016\/S0003-4975(98)00302-6","article-title":"A method for perfusion of the leg during cardiopulmonary bypass via femoral cannulation","volume":"65","author":"Hendrickson","year":"1998","journal-title":"Ann. Thorac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/0002-9610(54)90171-3","article-title":"Surgical therapy for the occluded artery","volume":"87","author":"Pratt","year":"1954","journal-title":"Am. J. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1536\/ihj.20-487","article-title":"Successful Treatment of Refractory Cardiogenic Shock and Electrical Storm Using the IMPELLA 5.0 with Atrial Overdrive Pacing, in a Patient with Severe Peripheral Arterial Disease","volume":"62","author":"Hasegawa","year":"2021","journal-title":"Int. Heart J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1055\/a-0998-4204","article-title":"Current Treatment Options in Acute Limb Ischemia","volume":"192","author":"Fluck","year":"2020","journal-title":"Rofo"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.avsg.2018.08.073","article-title":"Factors Associated with Ipsilateral Limb Ischemia in Patients Undergoing Femoral Cannulation Extracorporeal Membrane Oxygenation","volume":"54","author":"Yau","year":"2019","journal-title":"Ann. Vasc. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.athoracsur.2011.02.018","article-title":"Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support","volume":"92","author":"Bisdas","year":"2011","journal-title":"Ann. Thorac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/j.jtcvs.2004.03.042","article-title":"Pressure criterion for placement of distal perfusion catheter to prevent limb ischemia during adult extracorporeal life support","volume":"128","author":"Huang","year":"2004","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1111\/ans.13441","article-title":"Does a distal perfusion cannula reduce ischaemic complications of extracorporeal membrane oxygenation?","volume":"86","author":"Ma","year":"2016","journal-title":"ANZ J. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1177\/0267659119827231","article-title":"Risk factors for critical limb ischemia in patients undergoing femoral cannulation for venoarterial extracorporeal membrane oxygenation: Is distal limb perfusion a mandatory approach?","volume":"34","author":"Kaufeld","year":"2019","journal-title":"Perfusion"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1177\/0267659111430760","article-title":"A simple technique to prevent limb ischemia during veno-arterial ECMO using the femoral artery: The posterior tibial approach","volume":"27","author":"Spurlock","year":"2012","journal-title":"Perfusion"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1001\/jamasurg.2016.2018","article-title":"The Current State of Critical Limb Ischemia: A Systematic Review","volume":"151","author":"Farber","year":"2016","journal-title":"JAMA Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1111\/j.1540-8191.2009.00829.x","article-title":"Prevention of limb ischemia and edema during peripheral venoarterial extracorporeal membrane oxygenation in adults","volume":"24","author":"Russo","year":"2009","journal-title":"J. Card. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"E59","DOI":"10.1111\/j.1525-1594.2009.00909.x","article-title":"Prognostic factors for adult patients receiving extracorporeal membrane oxygenation as mechanical circulatory support\u2014A 14-year experience at a medical center","volume":"34","author":"Lan","year":"2010","journal-title":"Artif. Organs"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1510\/icvts.2009.220335","article-title":"Extracorporeal membrane oxygenation to support adult patients with cardiac failure: Predictive factors of 30-day mortality","volume":"10","author":"Formica","year":"2010","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/s13613-018-0445-z","article-title":"Fluoroscopy-guided simultaneous distal perfusion as a preventive strategy of limb ischemia in patients undergoing extracorporeal membrane oxygenation","volume":"8","author":"Jang","year":"2018","journal-title":"Ann. Intensive Care"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1177\/1558944718791189","article-title":"Why Not Life and Limb? Vasopressor Use in Intensive Care Unit Patients the Cause of Acute Limb Ischemia","volume":"15","author":"Newbury","year":"2020","journal-title":"Hand"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1097\/MAT.0000000000000858","article-title":"Impact of Cannula Size on Clinical Outcomes in Peripheral Venoarterial Extracorporeal Membrane Oxygenation","volume":"65","author":"Kim","year":"2019","journal-title":"ASAIO J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1016\/j.jtcvs.2015.01.042","article-title":"Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation","volume":"149","author":"Takayama","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1177\/155698451000500608","article-title":"Thromboembolic events in patients on extracorporeal membrane oxygenation without anticoagulation","volume":"5","author":"Lamarche","year":"2010","journal-title":"Innovations"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.healun.2019.01.1313","article-title":"A comparison of low and standard anti-coagulation regimens in extracorporeal membrane oxygenation","volume":"38","author":"Raman","year":"2019","journal-title":"J. Heart Lung Transplant."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"101427","DOI":"10.1016\/j.cpcardiol.2022.101427","article-title":"Impella Versus Extracorporeal Membranous Oxygenation (ECMO) for Cardiogenic Shock: A Systematic Review and Meta-analysis","volume":"48","author":"Ahmad","year":"2023","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_47","first-page":"e29916","article-title":"Save the Leg: Utilization of Distal Perfusion Catheter with Impella CP(R) May Prevent Morbidity of Limb","volume":"14","author":"McDermott","year":"2022","journal-title":"Cureus"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1097\/MAT.0000000000001584","article-title":"Novel Modification of Impella Sheath to Prevent Limb Ischemia","volume":"68","author":"Khan","year":"2022","journal-title":"ASAIO J."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/2\/485\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:29:42Z","timestamp":1760120982000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/2\/485"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,10]]},"references-count":48,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["life13020485"],"URL":"https:\/\/doi.org\/10.3390\/life13020485","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,10]]}}}