Different complications can ensue with the cannulation of the vessel for ECMO.
Early complications are directly related to the implantation procedure. Guidewire kinking, losing the vessel after full dilatation is achieved, vascular tears, not being able to advance the guidewire to the correct position due to anomalous bifurcation of the vessel, intimal dissection, and perforation are described.
Right ventricular rupture with cardiac tamponade [ 51 ] and myocardial infarction [ 52 ] are reported as complications with the insertion of the double-lumen cannula.
Bleeding from cannulation sites is still the most common complication reported in the literature [ 53 ]; with its occurrence techniques to improve vascular site hemo- stasis are implemented [ 54 ].
Ischemic alteration of the leg distal to arterial cannula is well described in VA ECMO, and a reperfusion cannula can be inserted electively to reduce the risk of limb ischemia. Strict monitoring of perfusion also in the venous side must be performed because a compartment syndrome can develop if the venous drainage from the distal leg is impaired by the big drainage cannula and edema develops due to a shock state. The frequency of short-term complications, including groin hema- toma , pseudoaneurysm , artero-venous fi stulae , and acute thromboembolism, varies between 2 % in VV ECMO and 8 % in VA ECMO,
Late complications affect around 12 % of VA ECMO patients and are mainly due to stenosis of the femoral artery at the former cannulation site, in particular with the surgical approach. Limb compartment syndrome occurs in about 1 % of VA ECMO patients and represents a very severe complication that can lead to amputation if not promptly recognized and treated [ 55 , 56 ].
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