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Episode 53 is all about the distal perfusion catheter12. We are inserting a 15-19 Fr catheter into the femoral artery. This limits the flow of blood to the affected extremity. Many institutions have gone to mandatory distal perfusion catheters. This episode is all about those catheters – when, how, which, and where. Joe Dubose, the world reknown vascular and trauma surgeon, joins us to discuss the details of this important piece of post pump initiation.
Take Homes –
- Common Femoral -> Superficial Femoral Artery or Posterior Tibial/Dorsalis Pedis
- Check distal perfusion frequently
- 5-7 Fr Catheters
- Doppler/Temperature/Color of distal extremity
- Remember side port of arterial ECMO catheter significantly limits the flow dynamics through the catheter
1.
Kaufeld T, Beckmann E, Ius F, et al. Risk factors for critical limb ischemia in patients undergoing femoral cannulation for venoarterial extracorporeal membrane oxygenation: Is distal limb perfusion a mandatory approach? Perfusion. February 2019:267659119827231. [PubMed]
2.
Lamb K, DiMuzio P, Johnson A, et al. Arterial protocol including prophylactic distal perfusion catheter decreases limb ischemia complications in patients undergoing extracorporeal membrane oxygenation. J Vasc Surg. 2017;65(4):1074-1079. [PubMed]
Joe is an ED Invasivist who endorses any procedure looking for an indication.
Zack is an ER doctor who enjoys a particular fondness for bringing people back from the dead. 
Scott is an ED Intensivist (whatever that means) who likes to talk to himself.