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Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a salvage therapy in patients with severe cardiopulmonary failure. Femoral cannulation is associated with limb complications including ischemia, limb loss, arterial infections and wound infections. This study aims to evaluate these complications and management related to successful outcomes. Methods: A retrospective review was conducted in 17 patients requiring VA- ECMO support via femoral cannulation from 1/ 2010 till 4/2012. After cannulation, all patients had near infared spectroscopy (NIRS) monitoring after cannula placement and most had placement of distal arterial perfusion catheters (DPC). At decannulation, all patients had femoral cutdown with closure of arteriotomies by primary repair or patch angioplasty with bovine pericardium. Primary study endpoints included ischemia, limb loss, arterial infection; secondary endpoints were wound infection and post-discharge symptoms. Results: Seventeen patients were supported with VA-ECMO during the study period with arterial cannula size of 16-20 French. All patients had NIRS monitoring after cannula placement and 13/17 patients had DPC placement, with no subsequent ischemia. Two of 4 patients without DPC developed ischemia; one was decannulated and the other resolved spontaneously. At decannulation, open arterial repair was performed as described. In this study population, simple wound infection occurred in 3/17with Vacuum Assisted Closure (VAC) devices were placed at the timed if appropriate. There were no arterial infections and no instances of limb ischemia requiring amputation. There were no complaints of rest pain during outpatient follow-up. Conclusions: Limb complications related to femoral cannulation for VA-ECMO can lead to prolonged morbidity and limb loss. NIRS and placement of DPC, primary repair of arteriotomy or patch angioplasty, along with aggressive wound care, can dramatically decrease rates of limb ischemia, limb loss and infection.

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