ID:113 FC-D07-9 Hemodynamic Impact of Distal Perfusion Catheter Type and Configuration on Limb Perfusion During Peripheral VA-ECMO: A Porcine Study

Background: Distal limb ischemia is a significant complication of femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO). Distal perfusion catheters (DPCs) are routinely used to mitigate ischemic injury; however, the influence of catheter type and connector configuration on distal limb perfusion remains unclear. This study evaluated the hemodynamic performance of different DPC strategies in a controlled porcine VA-ECMO model. Methods: Five adult pigs underwent femoral arterial and venous cannulation to establish peripheral VA-ECMO support. Two DPC strategies were evaluated: an 8 Fr introducer sheath and an 8 Fr arterial cannula. Each DPC was connected to the extracorporeal circuit using one of three connector configurations: small three-way connector, large three-way connector, or Y connector. ECMO flow was sequentially set at 25%, 50%, 75%, and 100% of native cardiac output. Distal superficial femoral arterial flow (mL/min) was measured using an ultrasonic transit-time flow probe. Data are presented as mean values. Statistical analysis was performed using two-way repeated-measures analysis of variance. Results: With the 8 Fr introducer sheath, distal arterial flow decreased: distal flow was 203.8 mL/min (small three-way), 149.6 mL/min (large three-way), and 134.4 mL/min (Y connector). The 8 Fr arterial cannula demonstrated progressive augmentation of distal flow with increasing ECMO flow. At 100% flow, distal flow reached 270.2 mL/min (small three-way), 307.4 mL/min (large three-way), and 376.0 mL/min (Y connector). The cannula with Y connector achieved a 2.8-fold higher distal flow compared with sheath with Y connector and a 1.85-fold increase compared with sheath with small three-way configuration. Conclusion: Distal limb perfusion during femoral VA-ECMO is significantly influenced by catheter type and connector configuration. Cannula-based DPCs, particularly with Y connectors, provide superior flow-responsive distal perfusion and may represent a modifiable strategy to reduce ischemic complications.