Short stature is associated with the development of lower limb ischaemia during extracorporeal life support

Background: Percutaneous cannulation of femoral vessels has been widely used for the rapid deployment of extracorporeal life support (ECLS). Limb ischaemia is a devastating complication in patients receiving ECLS. Our aim was to evaluate the predictors of limb ischaemia during ECLS and to determine the role of preventative distal perfusion.

Methods: Two hundred and fifty-five consecutive patients who received veno-arterial ECLS due to cardiac and/or respiratory failure were enrolled from January 2009 to December 2015. All patients received ECLS for more than 6 hours and the data was reviewed retrospectively. Distal perfusion to minimise lower limb ischaemia was performed at the discretion of the physician. Predictors for lower limb ischaemia during ECLS were analysed using multivariate regression analysis.

Results: For the 255 patients, the mean age was 58 and 177 (69.4%) were male. Limb ischaemia developed in 24 patients (9.4%); 178 patients (69.8%) died within 30 days. Among the 24 patients, one patient (4.2%) developed limb ischaemia with preventative distal perfusion. Fourteen patients (58.3%) received therapeutic distal perfusion. After distal perfusion, two patients (8.3%) still required surgical intervention. Limb ischaemia was more frequent in female patients (54.2% in the ischaemia group versus 28.1% in the non-ischaemia group, p=0.008) and shorter patients (162.0 ± 9.5 cm in the ischaemia group versus 166.3 ± 9.1 cm in the non-ischaemia group, p=0.027). Patients shorter than 165 cm were more commonly diagnosed with ischaemia compared to those who were taller than 165 cm (79.2% versus 40.7%, p<0.001). In a multivariate regression analysis, height under 165 cm was the only predictor for limb ischaemia (Odds ratio (OR) [95% confidence interval (CI)] = 12.645 [3.190-50.118]).

Conclusion: Smaller female patients are more prone to developing limb ischaemia from femoral ECLS. Our findings might support preventative distal perfusion and more careful observation of these patients.