What does this research mean for the field?

Vascular complications occur in 10–30% of peripartum VA-ECMO cases, with open surgical cannulation reducing late complications from 15% to 3% compared to percutaneous techniques. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 3, 2026

52: When ECMO Goes AWRY – Limb to Life Threatening Complications Post De-Cannulation in VA-ECMO

Key Result

Vascular complications occurred in 10–30% of peripartum VA-ECMO cases, with open surgical cannulation reducing late complications from 15% to 3%.

Key Points

The patient developed hypovolemic shock from intra-abdominal hemorrhage just six hours after decannulation, indicating severe post-operative risks.
She required open surgical repair after unsuccessful angiographic stenting for a left external iliac artery pseudoaneurysm, emphasizing complications of mechanical support.
Vascular complications in ECMO cases can occur in 10–30% of patients, highlighting the necessity for vigilant monitoring.
Open surgical cannulation showed a lower rate of late vascular complications, suggesting a need for careful procedural choices in ECMO cases.

Structured PICO

Population

26-year-old primigravida at 32 weeks of gestation with preeclampsia and peripartum cardiomyopathy with severe left ventricular dysfunction, complicated by cardiogenic shock post-cesarean section (n=1).

Intervention

Peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and subsequent decannulation.

Outcome

Vascular and systemic complications post-decannulation.safety

Severe, life- and limb-threatening vascular complications such as pseudoaneurysm and hemorrhage can occur post-decannulation in VA-ECMO, necessitating meticulous vascular management and multidisciplinary care.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background: Peripartum cardiomyopathy (PPCM) occurs in approximately 1 in 1400 pregnancies in India. Catastrophic presentations may necessitate mechanical circulatory support such as intra-aortic balloon pump (IABP), Impella, or veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Case Description: A 26-year-old primigravida at 32 weeks of gestation presented with worsening dyspnea for one week. She was diagnosed with preeclampsia and peripartum cardiomyopathy with severe left ventricular dysfunction. Following an emergency cesarean section, she developed cardiogenic shock with severe metabolic acidosis and was initiated on peripheral VA-ECMO. The patient was successfully weaned off ECMO and decannulated on day four while on IABP support. Six hours post-decannulation, she developed hypovolemic shock secondary to intra-abdominal hemorrhage. Ultrasonography revealed a left external iliac artery pseudoaneurysm with intra- and extraperitoneal hematoma. Angiographic stenting was attempted but unsuccessful, necessitating open surgical repair with femoro-femoral bypass. She required massive blood transfusion and developed multiple complications, including transfusion-related acute lung injury (TRALI), disseminated intravascular coagulation (DIC), and acute lung injury (ALI). Her clinical course was further complicated by left above-knee amputation, tracheostomy, and prolonged hospital stay. With rigorous multidisciplinary care, she was discharged in a stable condition after 45 days of hospitalization. Conclusion: Nearly 60% of all peripartum ECMO cases are due to cardiovascular causes, of which 17% result from PPCM. Vascular complications occur in 10–30% of ECMO cases and may be early or late. Open surgical cannulation is associated with fewer late vascular complications compared to percutaneous techniques (15% vs. 3%). This case highlights the importance of early recognition, meticulous vascular management, and multidisciplinary collaboration in achieving favorable outcomes in complex peripartum ECMO cases.

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