Case Reports
1 August 2025
Vol. 1 No. 1 (2023)
https://doi.org/10.4081/amsa.2023.15

Distal perfusion cannula on VA-ECMO: do not blindly trust! A case report

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ECMO, ECLS, ECPR, NIRS, distal perfusion cannula
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Authors

Rodrigo Diaz
rodrigoa.diaz@redsalud.cl
https://orcid.org/0000-0001-8046-2229
Pabellon Central, Red Salud Santiago, Pabellon Central, Santiago, Chile.
Marta Velia Antonini
https://orcid.org/0000-0003-4276-3404
Anesthesia and Intensive Care Unit, Bufalini Hospital - AUSL della Romagna, Cesena; Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy.

Distal perfusion cannulas (DPCs) are increasingly used to prevent limb ischemia, frequent and potentially serious complication on peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support. We report the case of a patient treated with femoro-femoral V-A ECMO who developed a sudden, significant asymmetric decrease in cannulated limb regional oxygen saturation, rSO2, signal, despite the presence of a DPC. This finding, noticed within 6 hours after the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) in a patient experiencing refractory intra-hospital cardiac arrest (IHCA), suggested ongoing limb ischemia. After careful monitoring, a clot was detected in the line supplying DPC, which appeared completely kinked at dressing removal. Line patency and reperfusion were promptly re-established. No additional ischemic episodes occurred, and the patient was successfully weaned from extracorporeal support, and experienced full functional recovery, with no sensory or motor deficit.

This case highlights the strict need for a careful, continuous monitoring of limb perfusion during V-A ECMO, even if limb perfusion through DPC is implemented, in order to prevent severe limb complications, negatively impacting on outcome.

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Distal perfusion cannula on VA-ECMO: do not blindly trust! A case report. (2025). Advances in Anesthesia and Pain Medicine, 1(1). https://doi.org/10.4081/amsa.2023.15
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