Mitigating limb ischemia in veno-arterial extracorporeal membrane oxygenation: A narrative review of evolving role of distal perfusion catheters

doi:10.5492/wjccm.120664

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World Journal of Critical Care Medicine

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2220-3141

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Crit Care Med. Sep 9, 2026; 15(3): 120664
Published online Sep 9, 2026. doi: 10.5492/wjccm.120664

Mitigating limb ischemia in veno-arterial extracorporeal membrane oxygenation: A narrative review of evolving role of distal perfusion catheters

Nupur Karan, Rohit Patnaik, Santi Swaroop Pattanaik, Arun Vijayakumar, Sugadev Ravinbothayan, Srikant Behera, Chinmaya Panda, Montasir Barakat, Alpa Meshram, Samir Samal, Atul Chawla

Nupur Karan, Chinmaya Panda, Department of Anaesthesiology, All India Institute of Medical Sciences, Raipur 492099, Chhattisgarh, India

Rohit Patnaik, Department of Critical Care Medicine, Medeor 24x7 Hospital, Abu Dhabi 40330, United Arab Emirates

Santi Swaroop Pattanaik, Department of Critical Care Medicine, Utkal Institute of Medical Sciences, Bhubaneshwar 751021, Odisha, India

Arun Vijayakumar, Department of Anesthesiology, Burjeel Hospital, Abu Dhabi 7400, United Arab Emirates

Sugadev Ravinbothayan, Department of Critical Care Medicine, Fortis Hiranandani Hospital, Navi Mumbai 400703, Mahārāshtra, India

Srikant Behera, Internal Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India

Montasir Barakat, Department of Critical Care Medicine, Burjeel Hospital, Abu Dhabi 7400, United Arab Emirates

Alpa Meshram, Department of Family Clinic, Medeor 24x7 Hospital, Abu Dhabi 40330, India

Samir Samal, Department of Critical Care Medicine, IMS and SUM Hospital, Bhubaneshwar 751003, Odisha, India

Atul Chawla, Department of Gastroenterology, Medeor 24x7 Hospital, Abu Dhabi 40330, United Arab Emirates

Author contributions: Karan N and Patnaik R wrote the original draft, contributed to the conceptualization, writing, reviewing, and editing; Karan N, Patnaik R, Pattanaik SS, Vijayakumar A, Ravinbothayan S, Behera S, Panda C, Barakat M, Meshram A, Samal S, Chawla A participated in drafting the manuscript; all listed co-authors authors provided intellectual contributions and made critical revisions to this paper; all authors have read and approved the final version of the manuscript.

Conflict-of-interest statement: The authors report no relevant conflicts of interest.

Corresponding author: Rohit Patnaik, MD, DM, Department of Critical Care Medicine, Medeor 24x7 Hospital, Al Falah Street, Abu Dhabi 40330, United Arab Emirates. rohitpatnaik09@gmail.com

Received: March 5, 2026
Revised: April 2, 2026
Accepted: April 24, 2026
Published online: September 9, 2026
Processing time: 175 Days and 19.5 Hours

Core Tip

Core Tip: Acute limb ischemia (ALI) is a major complication of femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO), driven primarily by impaired distal arterial flow and systemic vasoconstriction. Distal perfusion catheters (DPC) are the most commonly used preventive strategy, though optimal device choice, technique, and timing remain uncertain. Early monitoring with near-infrared spectroscopy and emerging tools such as bidirectional cannulas and artificial intelligence-based prediction models may further reduce risk. This review synthesizes current evidence on ALI in peripheral VA-ECMO and provides clear pictorial depictions of the pathophysiology, available methods, and contemporary techniques for DPC placement and practical monitoring.