Near-infrared spectrophotometry in the detection of vascular complications in extremities after implantation of ECMO-VA support: Comparison of results before and after the beginning of its use

After the implantation of a peripheral ECMO-VA type support, the appearance of complications such as limb ischemia could have devastating consequences since these are usually sedated patients who delay the diagnosis with subsequent necrosis, amputation or even the death of the patient. Our objective is to describe the benefits of near-infrared spectrophotometry (NIRS) for its ability to assess perfusion, in the surveillance and early detection of vascular complications, as well as assessment of the installed treatment.

Retrospective and descriptive study of patients with VA-ECMO type support who presented vascular complications before and after the establishment of a monitoring protocol with NIRS.

Of a total of 146 VA-ECMO implanted, prior to the action protocol, the appearance of vascular complications related to the puncture site was 24 (16.4%) cases, of which all (100%) required femoral plasty. and/or Fogarty, 1 case urgent surgery for retroperitoneal hemorrhage and 3 patients change of access site due to local complication, in addition 3 cases developed compartment syndrome after reperfusion and all 3 died. After monitoring the extremities with the NIRS and an action protocol, we have been able to see an improvement in our results. Although the percentage of occurrence of vascular complications is similar 20 (14.2%), early detection allows us to act more quickly and only 13 (66%) required femoral and/or Fogarty plasty, in addition only 1 case of post-reperfusion compartment syndrome , but by performing early fasciotomy his survival was achieved.

NIRS is a continuous monitoring system that allows the detection of a drop in perfusion in the extremity where VA ECMO is implanted, allowing early detection of a drop in perfusion and treatment.