Connecting a Distal Perfusion Catheter - Is there a Best Practice?
The use of distal perfusion catheters (DPC) during peripheral veno-arterial extracorporeal life support is a strategy to avoid distal limb ischemia and the associated complications with having minimal to no blood flow to an extremity. Some ECMO centers choose to immediately place a DPC to completely avoid this complication and give the affected limb the best possible outcome, while others wait and watch until assessment tells them it is time to intervene. Either way, the use of a DPC isn’t going away anytime soon.
❇️ Most ECMO Specialists know the process… connecting a DPC to the arterial cannula usually requires clamping the return tubing on either side of the connection to the cannula, backbleeding or wet priming the connection, connecting and then going back on support. Depending on the skill level of the clinician placing the catheter and the ECMO Specialist, this process can take anywhere from 10 seconds to a minute. This intervention can drastically impact the patient’s hemodynamics especially when native cardiac function is severely depressed. There are accounts of the mean arterial pressure plummeting to 40 during this one intervention, and although it is for mere seconds, what if this could be completely avoided?
Clinicians at UW Health in Wisconsin, USA shared a very practical tip in their latest abstract which was presented at ELSO. They connect a pre-primed, closed stopcock to the arterial cannula prior to it even being inserted into the patient. Problem solved! This circumvents the intervention of having to briefly go off of support. Way to think objectively and create a solution to unnecessary cessation of flow. ✅
Some may debate that this three way stopcock may not even be needed and can be an additional hazard such as a cracked connection. Risks and hazards always exist with every medical intervention and procedure, and if you are a part of an ECMO center that standardly places distal perfusion catheters, perhaps this practice tip is worth taking a closer look.
📎 Read their full abstract and findings here:
https://lnkd.in/dGPgJ6QR
Hext, Christian1; Niles, Scott1; Dollerschell, John1,2; McCauley, Matthew1,2; McCarthy, Daniel1,2; Glazer, Joshua1,2. 69: Streamlining ECPR Cannulation: A Preemptive Distal Perfusion Cannula Connection Technique. ASAIO Journal 70(Supplement 4):p 59, September-October 2024. | DOI: 10.1097/01.mat.0001070144.74005.96