85: Evaluating the Impact of Undergoing Fasciotomy or Lower Extremity Amputation while on Venoarterial Extracorporeal Membrane Oxygenation

Objectives: Lower extremity vascular complications are a major source of morbidity for patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) that may require fasciotomy or amputation. The objective of this study is to examine how fasciotomies and amputations affect VA-ECMO outcomes. Methods: A retrospective review of all patients who underwent VA-ECMO at our institution from January 2018 to September 2022 was performed and clinical data was extracted from the electronic medical record. Patients who underwent a lower extremity fasciotomy or amputation (FA) while on VA-ECMO were compared with those who did not (non-FA). Results: One hundred and forty-six patients met our inclusion criteria. Fasciotomy or amputation was performed on 8.2% (12) of patients. There were no significant differences in baseline demographics or VA-ECMO configuration between the FA and non-FA groups including BSA (2.03 vs. 2.13, p=0.64) or arterial cannula size (19.0 vs. 19.0 Fr., p=0.75). Most FA and non-FA patients had distal reperfusion cannulas ipsilateral to their femoral arterial cannula (75.0% (9) vs 67.9% (91), p=0.753). The FA group did have a significantly longer period of VA-ECMO support (7.5 vs 5 days, P=0.018) but no significant difference in survival to hospital discharge (25.0% (3) vs 38.3% (51), p=0.494) or median post-ECMO survival (281.5 vs 201.5 days, p=0.253). Conclusions: Our study found no significant differences in survival outcomes for FA patients but this may be secondary to our limited sample size. The length of VA-ECMO support was significantly longer in the FA group, which emphasizes the importance of consistent neurovascular checks.