Thigh compartment syndrome during extracorporeal life support

Objective: The aim of this study was to report our experience with patients on the extracorporeal life support system (ECLS) who presented with thigh compartment syndrome, a yet unreported complication. Methods: A retrospective analysis was performed from April 2003 to April 2017 to identify patients who presented to our department for treatment of acute compartment syndrome of the thigh after cannulation of the ECLS through the femoral artery and vein. Results: Five patients, aged 30 to 84 years, who developed thigh compartment syndrome during ECLS therapy were identified. In three patients, the cause was arterial malperfusion; in one patient, the cause was venous malfunction and arterial malperfusion due to malposition of the arterial distal leg perfusion cannula in the femoral vein. The fifth patient suffered impaired venous drainage. Patients were on ECLS for 4 +/- 2 days, and decompressive fasciotomy was performed in all patients 1 +/- 1 days after ECLS commencement. Thigh compartment syndrome was responsible for significant morbidity, including prolonged open wound therapy, hospitalization, and leg amputation in one patient. Conclusions: Compartment syndrome of the thigh is a limb- and life-threatening complication and may occur in patients on ECLS. Angiographic or duplex ultrasound control of adequate limb perfusion and correct placement of the perfusion cannulas is recommended. Also, awareness of and close clinical observation for thigh perfusion and compartment syndrome are essential in patients during ECLS therapy.