Vascular complications under venoarterial extracorporeal membrane oxygenation

Background Venoarterial extracorporeal membrane oxygenation (vaECMO) is an invasive and last resort treatment to maintain adequate organ perfusion in patients with treatment refractory cardiovascular failure. The implantation, management, and removal of vaECMO are associated with a significant rate of vascular complications, which are associated with a substantially worse patient outcome. Objective This article reviews the current literature and evidence-based clinical management of vascular complications in patients treated with vaECMO. Material and methods Based on a PubMed literature search, this article summarizes the results of current studies on vascular complications under vaECMO. Randomized controlled trials (RCT) and meta-analyses, if available, were prioritized in the literature selection along with recommendations from current national and international guidelines. Results The incidence of typical complications, accounting for slight variations in definitions, was 10-30% for limb ischemia, 10% for fasciotomy, 0.7-4.7% for amputations, 10-40% for bleeding and 3-5% for pseudoaneurysms. The routine use of sonography, preventive implantation of antegrade leg perfusion cannulas and a structured approach to vaECMO removal are important and effective strategies to reduce the rate of major vascular complications. Conclusion The evaluation of current studies reveals a consistently high incidence of vascular complications in patients on vaECMO. The implementation of preventive measures, standardized monitoring and coordinated interdisciplinary treatment pathways are essential for optimizing the management of these complications and potentially improving patient outcomes.