To the Editor:
We would like to share our experience regarding the use of regional anesthesia as an additional therapy in the intensive care unit for acute lower limb ischemia. A 40-year-old, 60-kg, 156-cm woman underwent lung transplant using right femoral venoarterial extracorporeal membrane oxygenation (ECMO) support for preoperative respiratory failure and right ventricle dysfunction related to pulmonary hypertension. Six days after surgery, the patient developed right lower limb ischemia downstream to the ECMO insertion site due to reperfusion cannula malfunction. The clinical improvement of cardiac and respiratory function allowed us to withdraw the ECMO support and perform a right superficial femoral artery embolectomy with a Fogarty catheter. Unfortunately, the right leg remained ischemic. Vascular ultrasound showed a major reduction of the right main tibial artery caliber, with an attenuated pulse-wave Doppler velocity (Fig 1, A and B). To improve perfusion, we performed a right popliteal sciatic nerve block with 15 mL of 0.475% ropivacaine under United States guidance. After the block, perfusion of the right leg was visibly improved. Vascular ultrasound showed a significant increase of the right main tibial artery caliber and pulse-wave Doppler velocity (Fig 1, C and D).
Lower acute limb ischemia is a major concern in patients undergoing venoarterial ECMO support.
1This was the second time in our practice that we successfully used a peripheral nerve block in a context of limb ischemia. We suggest that regional anesthesia could be a useful intervention after the primary cause of ischemia is treated (in this patient, after withdrawal of the ECMO cannula and arterial embolectomy).
- Bonicolini E
- Martucci G
- Simons J
- et al.
Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment.
Critical Care. 2019; 23: 266
Conflict of Interest
- Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment.Critical Care. 2019; 23: 266
Published online: September 24, 2022
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