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

Figure 1 Image showing the distal perfusion catheter in the left lower extremity. A: Shows distal perfusion catheter (green arrow), extension tubing with stop cock (orange arrow), venous cannula (blue arrow) and arterial cannula (yellow arrow); B: Close up view focussing on the distal perfusion catheter (green arrow) also showing connection with arterial cannula via a side port (black arrow), an intervening 3-way stop cock for regular flow check (white arrow) and a 6-inch extension tubing (orange arrow); C: Additional view showing distal perfusion catheter (orange arrow), venous cannula (blue arrow) and arterial cannula (yellow arrow).

Figure 2 Illustrative image showing correct positioning and connection for placing the distal perfusion catheter. Image shows the femoral artery with both a distal perfusion catheter and an arterial cannula inserted in opposite directions. The shaded region represents the zone where blood flow is reduced by the presence of both cannulas. SFA: Superficial femoral artery; DPC: Distal perfusion catheters; CFA: Common femoral artery.

Figure 3 Multifaceted approach to monitoring limb ischemia on veno-arterial extracorporeal membrane oxygenation. VA-ECMO: Veno-arterial extracorporeal membrane oxygenation; NIRS: Near-infrared spectroscopy.

Figure 4 Left lower extremity image showing signs of limb ischemia with darkening of the skin which has been demarcated (orange arrow). A brown coloured topical nitroglycerin patch is seen attached (black arrow).