Table 1 Manuscript included for Review

Sabashnikov, 2018 [24]

R

28 pts.

(15 under CPR):

3 (11%) ARDS

1 (3%) DCM

17 (61%) ICM

5 (18%) PAE

1 (3%) MIO

1 (3%) PCS

Primary:

Early and mid-term overall cumulative survival (2 years follow-up)

Secondary:

-Incidences of ECMO-related complications,

-Impact of CPR on outcome and changes in hemodynamics

-Tissue perfusion factors 24 h after cannulation

NA

96 ± 100 h

11 (40%)

21–23 Fr

PC 27 (90%)

SCD 1 (10%)

NA

3 (10%)

Pre-emptive

19 (68%)

6.5 (6.5–8)

Surgical exploration of the femoral artery and embolectomy using a Fogarty catheter.

Park, 2018 [25]

R

255 pts. with HF and/or ARF

Identify risk factors for lower limb ischemia

CAD 83 (32.5%)

PVD 5 (2%)

89.8 h

NA

(30 days survival 69.8%)

16.5 ± 1.8

PC

NA

24 (9.4%)

Pre-emptive 23 (9%)

Rescue 14 (5.5%)

5–7 Fr

2 surgical catheter removal (functional deficit).

14 rescue DPC

(Of those, 2 needed surgical intervention and survived with functional deficit.)

Yen, 2018 [14]

R

139 pts.:

LI group n = 46

No LI group n = 93

Identify pre-cannulation variables that are associated with limb ischemia and selection criteria for using DPC for prevention of limb ischemia

No LI group:

DM 16 (17%)

HT 28 (30%)

Uremia 10 (11%)

PVD 8 (9%)

LI group:

DM 10 (22%)

HT 17 (37%)

Uremia 8 (17%)

PVD 11 (24%)

NA

No LI group: 69 (74%)

LI group: 25 (54%)

16.5 ± 0.8

PC

NA

46 (33%)

Rescue

6 Fr

NA

Burrell, 2018 [26]

R

144 pts

Complications and outcomes of patients who were commenced on ECMO at a referring hospital compared with patients who had ECMO in a referral center for ECMO.

S 35 (26%)

CAD 35 (26%)

DM 16 (12%)

HF 69 (53%)

CT 18 (13%)

7 (4–11) days

105 (72.9%)

17–19 Fr

PC

NA

1 (0.7%)

Pre-emptive

9 Fr

Resolved after DPC insertion at the referral center

Voicu, 2018 [27]

R

46 pts. with refractory CA

Analyze the feasibility and the time interval required for percutaneous cannulation versus anatomic landmark cannulation for va ECMO.

S 21 (46%)

DM 5 (11%)

HT 17 (37%)

HL 15 (33%)

NA

4 (9%)

15–17-19 Fr

PC

NA

0

Pre-emptive

4 Fr

NA

Salna, 2018 [28]

R

192 pts. with CS:

35% AMI

23% PCS

18% ADHF

15% PGD

8.9% other

Incidence of in-hospital lymphocele formation in VA-ECMO patients and identify predictors for its development

DM 65 (33.9%)

CKD 52 (27.1%

PVD 19 (9.4%)

4 (2–6) days

120 (62.5%)

15–17 Fr

SCD 88 (45.8%)

Surgical

16 (8.3%)

Preventive based on Doppler signal at cannulation

6–10 Fr

NA

Lamb, 2017 [29]

R

91 patients:

CS 73 (80%);

ARF 14 (15%)

PE 3 (4%)

VAD failure 1 (1%)

Evaluation of an ischemia prevention protocol

HT 53 (58%)

DM 26 (29%)

HL 34 (37%)

OB 30 (33%)

CLD 15 (17%)

PVD 6 (7%)

CKD 27 (30%)

9 days

38 (42%)

16-24 Fr on pressure-flow curve and pts. size

PC

Surgical

12 (13%) all in patients without preventive DPC

Preventive 55 (60%)

Rescue 7 (8%)

5 Fr

DPC 2 (2.2%)

DPC+ Fasciotomy 5 (5.5%)

Fasciotomy 4 (4.3%)

Pasrija, 2017 [30]

R

20 pts. with PE

Primary outcome:

In-hospital and 90-day survival.

Secondary outcomes:

-Acute kidney injury that required renal replacement therapy

-New hemodialysis at discharge

-Sepsis,

-Tracheostomy,

-RV dysfunction at discharge

-ECMO-related complications (bleeding that required blood product, stroke after cannulation and vascular complications)

NA

5.1 (3.7–6.7) days

19 (95%)

17–19 Fr

PC

NA

0

Pre-emptive

6 Fr

1 vascular injury due to retrograde type B dissection after ECMO cannulation. Required central cannulation.

Vallabhajosyula, 2016 [31]

R

105 pts. on femoral VA-ECMO:

G1 = no DPC

G2 = PC DPC

G3 = Surgical DPC

Assess if the type of limb perfusion strategy influenced the rate and severity of ipsilateral limb ischemia in peripheral ECLS patients

DM 24 (33%)

HT 39 (37%)

S 22 (21%)

G1 87.7 ± 119 h

G2 88.5 ± 121 h

G3 89.2 ± 120 h

G1 21 (60%)

G2 14 (61%)

G3 32 (68%)

16–20 Fr

NA

NA

G1 7 (20%)

G2 6 (26%)

G3 1 (2.1%)

Pre-emptive 70 (67%)

7 Fr

4 tromboembolectomy + artery repair

4 fasciotomy

3 cannulation revision

1 amputation

Yeo, 2016 [32]

R

151 pts.:

G1 = pre-emptive DPC (44pts)

G2 = rescue DPC (107 pts)

Evaluate the efficacy of pre-emptive DPC during ECMO support in term of limb ischemia prevention

DM 25 (16.4%)

HT 39 (25.7%)

CKD 6 (3.9%)

S 27 (17.8%)

PVD 11 (7.2%)

CVD 5 (3.4%)

G1 4.9 ± 4.9 days

G2

6.0 ± 5.4 days

(Overall mortality G1 66 (61.7%)

G2 17 (38.6%))

G1 17.2 ± 2.1 Fr

G2 17.9 ± 1.8 Fr

PC

NA

10 (6.7%) all in G2

Pre-emptive G1

Rescue G2

5–8 Fr

2 DPC

2 fasciotomy

1 amputation

5 died before therapeutic intervention

Avalli, 2016 [33]

R

100 pts.:

G1 with vascular complications 35 (35%)

G2 without vascular complications 65 (65%)

Primary endpoint was early vascular complication rate. Secondary endpoint was 1-month and 6-month survival

PVD 8 (8%)

CAS 4 (4%)

HT 59 (59%)

DM 19 (19%)

S 25 (25%)

HL 20 (20%

OB 13 (13%)

G1

5 (3–6) days

G2

4.5 (2–9) days

G1 15 (43%)

G2 13 (20%)

15–17 Fr

PC

Manual compression 30′ + SafeGuard

34 (34%)

Rescue

7–9 Fr

30 DPC

6 fasciotomy

1 amputation

Tanaka, 2016 [19]

R

84 pts. on pVA-ECMO.

17/84 with vascular complication (G1)

67/84 without vascular complication (G2)

Impact of vascular complications on survival in patients receiving VA ECMO by means of femoral percutaneous cannulation.

S 28

CAD 34

PVD 3

DM24

COPD 10

G1

14.6 ± 6.7

G2

10.6 ± 7.5

G1 3 (18%)

G2 32 (48%)

G1 19.8 ± 2.3

G2: 19.7 ± 1.7

PC

Surgical

10 (12%)

Pre-emptive except 7 (41%) G1

10 (15%) G2

NA

Prophylactic fasciotomy

Ma, 2016 [34]

R

70 pts.

PCS 44 (63%)

ECPR 21 (30%)

ARF 5 (7%)

To identify predictive factors for vascular complications, and provide insight into how to reduce these complications

NA

NA

NA

15–24 Fr

44 (63%) SCT

25 (36%) PC

1 not recorded

Surgical

14 (20%)

33 Pre-emptive

6 Rescue

6–8.5 Fr

6 DPC rescue

1 embolectomy

1 fasciotomy

1 embolectomy+ femoral artery repair

1 amputation

Esper, 2015 [35]

R

18 pts. with ACS complicated by CS

Single-center experience

DB 5 (27.8%)

HT 9 (50%)

HL 2 (11.1%)

S 3 (16.7%)

PVD 3 (16.7%)

3.2 ± 2.5 days

67%

15–17 FR

PC

NA

4 (22%)

Rescue

NA

DPC

Takayama,2015 [36]

R

101

Group L:

(n 51)

Group S

(n 50)

To compare the clinical outcomes of 2 strategies: conventional approach

(using a 15F–24F cannula- Group L) or smaller cannula of15 Fr (Group S)

Group L

CAD 22 (43)

Ht 26 (51)

HL 15 (29)

DM 17 (33)

COPD 17 (14)

Group S

CAD 31 (62)

HT 33 (66)

HL 23 (46)

DM 16 (32)

COPD 5 (10)

Group L

3.4 (1.0–6.1) days

Group S 3.1 (1.9–5.1) days

Group L

31 (61%)

Group S 27 (54%)

Group L

17 to 24Fr

Group S

15 Fr

Group L

PC 22 (43)

SCD 29 (57)

Group S

PC 44 (88)

SCD 6 (12)

NA

Group L

2 (4)

Group S 2 (4)

Group L 19%

Group S

18%

Inserted if distal doppler signal is lost

NA

NA

Truby, 2015 [37]

R

179 pts. with CS

Trends in device usage, and

analysis of clinical outcomes

CAD 82 (45.8%)

HL 72 (40.2%)

HT 103 (57.5%)

CLD 16 (8.8%)

DB 52 (29.1%)

3.58 days

69 (38.6%)

15–23 Fr

NA

NA

25 (13.9%)

9 Rescue

NA

2 Fasciotomy

Saeed, 2014 [38]

R

37 pts.:

25 p VA ECMO

Compare outcome of cECMO versus pECMO patients in the immediate postoperative period.

DM 3 (12%)

HT 13 (52%)

HL 8 (32%)

CAS 3 (12%)

CKD 9 (36%)

Re-do surgery 5 (20%)

5.8 ± 4.3 days

(30-day mortality 60%)

18–22 Fr

NA

NA

4 (16%)

Pre-emptive

NA

All required surgical intervention

Aziz, 2014 [39]

R

101 pts

Incidence of peripheral vascular complication

HT 33 (32.7%)

DM 22 (21.8%)

HL 22 (21.8%)

S 20 (19.8%)

7.3 days

59 (58.4%)

15–17 Fr

PC

S

8 (8%)

77 (77%) Pre-emptive

NA

8 arterial cannula removal

4 femoral endoarterectomy with patch angioplasty

1 amputation

Papadopoulos, 2014 [40]

R

Total: 360 PCS.

120 (37%) femoral pVA-ECMO

Identification of risk factors for adverse outcome (failed ECLS weaning or in-hospital mortality)

COPD 32 (9%)

HT 227 (63%)

PH 31 (17%)

DM 151 (42%)

CVD 22 (6%)

PVD 65 (18%)

S 122 (34%)

CKD 40 (11%)

7 ± 1 days

108 (30%)

NA

Seldinger or 8-mm Dacron Graft

NA

20 (17% of femoral pVA-ECMO)

NA

NA

Fasciotomy 18 (5% of total pts)

NA data on femoral pVA-ECMO pts.

Stub, 2014 [41]

SC-POT

26 pts. ECPR (24 cannulated)

Primary outcome:

Survival with good neurologic recovery

Secondary outcomes:

Rates of ROSC, successful weaning from ECMO support and ICU and hospital length of stay.

HT 11 (42%)

HL 11 (42%)

DM 2 (8%)

HF 5 (19%)

CAD 4 (15%)

2 (1–5) days

14 (54%)

15 Fr

PC

S

10 (42%)

As soon as possible after ICU admission

8.5 Fr

9 femoral artery repair and surgical placement of DPC

1 fasciotomy

Mohite, 2014 [42]

R

45 pts.:

14 ADHF

8 PCS

6 CS

15 Post CT

2 Bridge to LungT

Compare pts. outcomes focusing on the distal limb perfusion methods (perfusion cannula VS introducer sheat)

NA

Perfusioncannula group:

11.9 ± 9.1 days

Introducer sheat group

7.7 ± 4.3

19 (42.2%)

19–21 Fr

20 (44.5%) PC

14 (31%) SCT

11 (24%) Hybrid

NA

9 (20%)

Pre-emptive

Perfusion cannula 10–12 Fr

Introducer sheat 6–8 Fr

5 (11.2%) conservative

4 (8.8%) surgery

1 amputation

Spurlock, 2012 [43]

R

On 154 patients (data on 36 patients in PTA-DPC)

Posterior tibial artery for DPC placement

NA

5.8 days

63 (41%)

15–24 Fr on surgeon decision

PC

Direct pressure 30 mins

Available only for PTA-DPC group) 3 (8.3%)

DPC in 68 (44%)

PTA-DPC in 36 (24%): 20 (58%) within 6 h of ECMO; 16 (42%) after 6 h of ECMO

6–8 Fr

(Available only for PTA-DPC group)

2 amputation

1 neuropathy

Wong, 2012 [44]

R

20 pts.: 17 (85%) on VA-ECMO

Report single-center experience on cerebral and lower limb NIRS

NA

7 (2–26) days

NA

NA

PC

NA

6 (35%) diagnosed with drop in unilateral lower limb NIRS tracings

Pre-emptive

NA

4 two-compartment prophylactic fasciotomy

Wernly, 2011 [45]

R

51 pts. with Hantavirus cardiopulmonary syndrome

Evaluate the outcome of ECMO support in Hantavirus cardiopulmonary syndrome (HCPS) patients

NA

121.7 h

34 (66.6%)

15–21 Fr

PC 18 (35.3%)

SCD 33 (64.7%)

SCD

4 (8%)

Pre-emptive

8–10 Fr

2 thrombectomy, embolectomy, and insertion of an additional cannula in the superficial femoral artery.

2 Amputations

Ganslmeier, 2011 [46]

NA

158 pts

Reviews cannulation strategies and associated vascular complications

NA

3.6 ± 5.2 days

32 (20%)

13–15–17-19 Fr

PC

SCT if femoral vessels were small during sonography

Safeguard system

13 (8.2%)

NA

NA

50% Surgical revision and vascular reconstruction

100% prophylactic fasciotomy

Bisdas,2011 [15]

R

143 pts. with ECMO VA

To evaluate such complications to outline basic technical principles for their prevention.

HT 77 (44%)

CKD 53 (30%)

CAD 47 (27%)

COPD 25 (14%)

DM 29 (17%)

PAD 15 (9%)

6 days (range, 1 to 11 days).

26%

15F or 17F

Percutaneous

cannulation in 136 (95%) and by open vessel exposure in 7 (5%).

Manual compression, and femoral compression system

8 pts

Pre-emptive

6F

2 amputation

Foley, 2010 [47]

R

43 pts. on femoral pVAECMO

Examine the outcomes of patients placed on ECMO, including the rate of limb ischemia

NA

NA

NA

Li group

16.9 ± 1.1

No li group

18.0 ± 1.7

Pre-emptive DPC group

17.7 ± 1.8

PC

Surgical

7 (21%)

10 pre-emptive

3 Rescue

NA

4 Decannulation and fasciotomy

3 rescue DPC

1 amputation

Arlt, 2009 [48]

R

13 pts.:

10 (77%) CS

3 (27%) Septic shock

Report 9 years emergency ECMO application

NA

3.5 ± 2.9 days

8 (62%)

15–17 Fr

PC

NA

6 (46%)

Not used

NA

Resolved limb ischemia after cannula switch from the femoral artery to the right subclavian artery.