Venous or Arterial Thromboses after Venoarterial-Extracorporeal Membrane Oxygenation Support: Frequency and Risk Factors

BACKGROUND Although venous thrombosis after venovenous–extracorporeal membrane oxygenation (ECMO) is well described, vascular complications occurring after venoarterial ECMO (VA-ECMO) removal have not yet been thoroughly described. Our aim was to evaluate the frequency of vascular (arterial and venous) complications after VA-ECMO removal and try to identify the risk factors associated with them. METHODS Retrospective analysis of data prospectively collected in 2 intensive care units was performed. Consecutive patients successfully weaned off VA-ECMO during year 1 were screened for cannula-associated deep vein thrombosis (CaDVT) or arterial complications (arterial thrombosis/stenosis) using Doppler ultrasonography . RESULTS From November 2018 to November 2019, a total of 107 patients with a median (interquartile range [IQR]) age of 54 (42–63) years and a median (IQR) ECMO support duration of 8 (2–5) days were successfully weaned off VA-ECMO and included. CaDVT occurred in 44 patients (41%), and arterial complications occurred in 15 (14%) (9 acute leg ischemia , 1 arteriovenous femoral fistula , and 5 late femoral stenosis). Multivariable analysis retained longer duration of ECMO support (odds ratio [OR]: 1.12 per day; 95% CI: 1.02–1.22) and infection occurring on ECMO (OR: 3.03; 95% CI: 1.14–8.03) as independent risk factors for CaDVT, whereas older age (OR: 0.97 per year; 95% CI: 0.94–0.99) and previous anti-coagulation use (OR: 0.21; 95% CI: 0.06–0.68) were protective factors for CaDVT. No risk factors for arterial complications were identified. CONCLUSIONS In patients requiring VA-ECMO support, vascular complications occurred frequently after its removal, especially CaDVT. Arterial complications, either early leg ischemia or late arterial stenosis , were observed less often. Strategies aimed at preventing CaDVT after VA-ECMO remain to be determined.