Lower Limb Surveillance During VA-ECLS

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

40 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-04-01

Study Completion Date

2020-06-01

Brief Summary

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Temporary cardiac support by VA-ECLS can lead to lower limb ischemia. The aim of this study is to evaluate a multi-modal strategy (physical examination, NIRS monitoring and angiography through the reperfusion canula) of lower limb surveillance.

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Detailed Description

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VA ECLS is used as a temporary circulatory support during cardiogenic shock and refractory cardiac arrest. Complications of VA ECLS include hemorrhagic, infectious and ischemic events. VA ECLS requires arterial and venous canules which are frequently positioned in the femoral artery and vein, which carries the risk of lower limb ischemia due to retrograde flow and obstruction of the femoral artery lumen. VA ischemia during VA ECLS is frequent (11-52%) and requires the use of reperfusion canula in the femoral common artery on VA ECLS implantation in a primary prevention strategy, before lower limb ischemia occurs. Even with this strategy, lower limb ischemia can occur due to arterial thrombosis, arterial spasm or insufficient blood flow through the reperfusion canula. Lower limb complications are prevented by monitoring of regional oxygen saturation, control of the reperfusion canula position (ultrasound, angiography) and rapid management when lower limb ischemia is suspected. There are no clear recommendations regarding prevention of lower limb complications during VA ECLS and arterial angiography has been described to diagnose ischemic events and evaluate the effectiveness of an intervention such as injection of vasodilators. This study is a prospective evaluation of a strategy to prevent lower limb complications during VA ECLS with a systematic arterial angiography on VA ECLS implantation and when lower limb ischemia is suspected (regional oxygen tissue saturation \<50% or a differential \>15% between both lower limbs) in addition to continuous NIRS monitoring of lower limbs during VA ECLS.

Conditions

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Cardiogenic Shock Cardiac Arrest Lower Limb Ischemia

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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VA ECMO

Patients under VA-ECMO with a femoral reperfusion cannula.

Lower limb angiography via the reperfusion cannula and NIRS monitoring

Intervention Type PROCEDURE

Data collection only (lower limb angiography, lower limbs NIRS values).

Interventions

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Lower limb angiography via the reperfusion cannula and NIRS monitoring

Data collection only (lower limb angiography, lower limbs NIRS values).

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Temporary circulatory support with VA ECLS
* Age \> 18 years

Exclusion Criteria

* Pregnancy
* History of iodinated contrast allergy
* History of lower limb amputation above the ankle
* Lower limb ischemia before starting of VA-ECLS
* Femoro-axillary VA-ECLS
* Absence of the lower limb reperfusion canula

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No