ECMO is usually applied to the whole body. In VA-ECMO, we often use a smaller side cannula to supply the lower limb with circulation and oxygenated blood, when its femoral artery is partially occluded by the main ECMO cannula.

Selected lower limb perfusion
The Germans took this one step further during a traumatic amputation victim who had a complete amputation of the leg at the level of the pelvic ring. They connected the amputated limb to an ECMO circuit. The limb was cannulated at the torn femoral artery and vein and perfused with 1L/min for 12 hours, to keep it circulated and alive for long enough to stabilise the patient and use tissue from the amputated limb for reconstructive surgery.

The result was the patient had enough tissue to do a reconstruction that allowed him to get a working prosthetic limb and return to work 5 months later.

The case was presented at theĀ 47th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) in Leipzig, Germany, February 2018, but unfortunately, only the abstract for the case is available online. Still, a very interesting case and great outside-the-box thinking.

Extracorporeal Circulation in a Trauma Patient: An Unusual Case of Selected Lower Limb Perfusion, ThoracĀ cardiovasc surg, 2018.

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