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Abstract
Objectives Venoarterial extracorporeal membrane oxygenation is increasingly being used as a life-saving modality in critically ill patients. Despite its necessity, severe lower extremity ischemia associated with venoarterial extracorporeal membrane oxygenation remains a potentially devastating complication. We aimed to investigate the incidence and risk factors for severe lower extremity ischemia requiring fasciotomy or amputation following venoarterial extracorporeal membrane oxygenation.
Methods All patients who received venoarterial extracorporeal membrane oxygenation during hospitalization were identified in a Japanese national inpatient database from July 1, 2010 to March 31, 2018. The primary outcome was occurrence of severe lower extremity ischemia that required fasciotomy or amputation. We used cause-specific proportional hazard models to examine the associations between potential risk factors and outcomes. We also performed a competing-risk analysis to estimate the cause-specific HR for severe lower extremity ischemia using a multivariable competing-risk Cox proportional hazard model with adjustment for potential risk factors.
Results A total of 29 231 patients who underwent venoarterial extracorporeal membrane oxygenation during hospitalization were identified. Of these, 98 patients (0.3%) had lower extremity ischemia requiring fasciotomy or amputation. The young group (≤18 years) had a significantly higher proportion of severe lower extremity ischemia cases than the adult (19–59 years) and elderly (≥60 years) groups (1.4%, 0.5%, and 0.2%, respectively; p<0.001). In a multivariable competing-risk Cox proportional hazards regression model, younger age (HR 3.06; 95% CI 1.33 to 7.02; p<0.008) and consciousness disturbance on admission (HR 2.53; 95% CI 1.60 to 3.99; p<0.001) were significantly associated with higher likelihood of severe lower extremity ischemia.
Conclusion In this study using a nationwide database, younger age and consciousness disturbance on admission were associated with higher risk of severe lower extremity ischemia following venoarterial extracorporeal membrane oxygenation.
Level of evidence Level Ⅲ—prognostic and epidemiological.
- extracorporeal membrane oxygenation
- risk factors
- compartment syndrome
- amputation
Data availability statement
Data are available on reasonable request. The datasets analyzed during the current study are not publicly available due to contracts with the hospitals providing data to the database.
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Data availability statement
Data are available on reasonable request. The datasets analyzed during the current study are not publicly available due to contracts with the hospitals providing data to the database.
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Footnotes
Presented at The University of Tokyo, Gunma University Graduate School of Medicine.
Contributors All authors contributed to the study conception and design. AH and YI designed and executed the experiments and wrote the manuscript. NM and YI were a major contributor to in writing the manuscript. NM, KU, and KM contributed to introduce the clinical epidemiology and helped to conduct statistical analysis and to write the manuscript. YI, TM, ET, SI, and TT contributed to introduce the concept of orthopaedic surgery and helped to write the manuscript. HM and KF contributed to construct the database. HY and HC are supervisors and edited the manuscript. All authors reviewed and approved the final manuscript. AH accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and 20AA2005) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (20H03907).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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