Key result
Higher capillary refill time (OR 27.571) and lower tissue oxygen saturation (OR 0.615) were independently associated with an increased risk of lower limb ischemia in patients receiving VA-ECMO.
Why the study?
VA-ECMO can cause lower limb ischemia, but high-risk factors for this complication required exploration.
Are capillary refill time and tissue oxygen saturation independent risk factors for lower limb ischemia in patients receiving VA-ECMO?
Case-Control (n=117)
No
Are capillary refill time and tissue oxygen saturation independent risk factors for lower limb ischemia in patients receiving VA-ECMO?
Odds Ratio: 27.571
p-value: p=<0.05
Monitoring capillary refill time and tissue oxygen saturation can help identify VA-ECMO patients at high risk for lower limb ischemia.
CRT and StO2 were associated with limb ischemia risk after VA-ECMO; leaves open whether monitoring improves outcomes in prospective studies.
Venous-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a pivotal means for rapid cardiopulmonary support, yet it may result in lower limb ischemia. This study aims to explore the high-risk factors for lower limb ischemia following VA-ECMO. 117 patients who received VA-ECMO treatment at Guangxi Zhuang Autonomous Region People’s Hospital from June 2022 to December 2023 were divided into lower limb ischemia group and non ischemia group for case-control analysis. In this case-control study of 117 VA-ECMO patients, 22 (18.80%) experienced lower limb ischemia. Patients with ischemia had significantly lower body surface area (BSA) and lower tissue oxygen saturation (StO 2 ) levels, but higher capillary refill time (CRT) levels compared to those without ischemia ( P < 0.05). Spearman correlation analysis showed that StO 2 and CRT had strong correlations with ischemia. Binary logistic stepwise regression analysis identified CRT and StO 2 as independent risk factors for lower limb ischemia. Specifically, lower StO 2 levels were associated with an increased risk of ischemia (OR = 0.615, P < 0.05), while higher CRT levels were also associated with an increased risk (OR = 27.571, P < 0.05). The Receiver Operating Characteristic (ROC) curve shows that the areas of CRT and StO 2 are 0.924 ( P < 0.001, 95% CI 0.866–0.983) and 0.951 ( P = 0.023, 95% CI 0.906–0.997), respectively. StO 2 reflects real-time tissue perfusion adequacy, whereas CRT serves as a marker of microvascular dysfunction. Lower StO 2 levels (indicating impaired oxygenation) and higher CRT levels (suggesting delayed capillary refilling) were independently associated with an increased risk of lower limb ischemia, suggesting that monitoring these parameters may be useful in identifying patients at higher risk for this complication. These findings provide valuable insights for risk stratification and potential intervention strategies in the management of VA-ECMO patients.
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Liu et al. (2025) conducted a case-control in Lower limb ischemia following VA-ECMO (n=117). Higher capillary refill time (CRT) and lower tissue oxygen saturation (StO2) vs. Lower CRT and higher StO2 was evaluated on Lower limb ischemia (OR 27.571, p=<0.05). Higher capillary refill time (OR 27.571) and lower tissue oxygen saturation (OR 0.615) were independently associated with an increased risk of lower limb ischemia in patients receiving VA-ECMO.
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