Introduction: Acute compartment syndrome (ACS) has historically been diagnosed through clinical suspicion, which may be unreliable in critically ill patients on mechanical circulatory support (MCS). Continuous compartment pressure monitoring offers a potential paradigm shift toward earlier, more objective diagnosis of ACS, a feared and underrecognized complication of MCS. Methods: We describe the use of MY01, a continuous compartment pressure monitoring device, in four patients on MCS who were suspected of developing ACS with indistinct clinical signs. Case one involves a 68-year-old male with cardiogenic shock post-catheterization requiring Impella RP and VA-ECMO who developed bilateral forearm ACS despite dopplerable pulses. Case two describes a 59-year-old male with a post-myocardial infarction pseudoaneurysm repair on VV-ECMO who developed left leg ACS despite distal perfusion catheter placement. Case three features a 61-year-old female with acute heart failure exacerbation bridged to LVAD implantation who developed right forearm ACS suspected by spontaneous peripheral intravenous (PIV) line extravasation. Case four involves a 59-year-old male with acute respiratory distress syndrome post-bilateral lung transplant on VV-ECMO who developed left forearm ACS despite patent arterial and PIV lines. Results: Continuous compartment pressure monitoring played a critical role in confirming the diagnosis of ACS and guiding timely intervention. Each patient demonstrated sustained elevated compartment pressures (≥20–50 mmHg) on MY01 monitoring, which directly informed the decision to proceed with emergent fasciotomy. Outcomes varied: two patients achieved full functional recovery; one underwent limb salvage following a complicated postoperative course; and one patient expired due to multi-organ failure unrelated to compartment syndrome or the intervention. No device-related complications were observed. Conclusions: These cases highlight the limitations of clinical assessment alone in diagnosing ACS in critical care patients and support the utility of continuous pressure monitoring as an adjunctive diagnostic tool. Early data suggest that the integration of such monitoring could improve limb salvage rates, reduce delays to intervention, and potentially avoid unnecessary fasciotomies.
Erkan et al. (Sun,) studied this question.