9 - Safety and Clinical Outcomes of Ultrasound-Guided Bedside Antegrade SFA Sheath Placement for Limb Salvage in Critically Ill Patients with Peripheral Veno-Arterial Extracorporeal Membrane Oxygenated (ECMO) Cannulation

Purpose: To assess complication rates, demographics, and clinical outcomes following bedside ultrasound (US)-guided antegrade superficial femoral artery (SFA) sheath placement for extracorporeal membrane oxygenation (ECMO) patients with existing retrograde common femoral artery (CFA) access. Despite increasing use of this technique, data on risks and outcomes remain limited. {1-5}

Materials and Methods: A single-center retrospective chart review (2015-2025) identified patients on veno-arterial ECMO with retrograde CFA access who underwent antegrade SFA sheath placement. Demographics, procedural details, complications, and outcomes were collected via chart review in with HIPAA and institutional protection policies. Subgroup comparisons were made between bedside US-guided and angiographic (angio) suite US/fluoroscopic guided placements. Categorical variables were summarized with frequencies and percentages; Fisher’s exact test and Mann–Whitney U test were used for analysis.

Results: Fourteen patients were included, 8 at bedside with US-guidance and 6 in the angio suite with US and fluoroscopic guidance. Mean age was 52.5 and 57 years, respectively. Time from ECMO initiation to sheath placement differed significantly [14.8 hours bedside vs. 3.1 hours angio suite]. Technical success was achieved in 93% of cases. Sheath-related complications occurred in 50% of patients at bedside and 37.5% in the angio suite, most commonly bleeding and pseudoaneurysm formation; no dissections were noted. Hospital and ICU length of stay, complications, and mortality rate did not significantly differ between the two groups. No deaths were attributed to sheath placement, but rather patient factors.

Conclusion: Bedside US-guided antegrade SFA sheath placement in ECMO patients demonstrated high technical success; complication rates were comparable to angio suite placement. Despite sheath-related complications, clinical outcomes were similar, supporting bedside placement as a feasible alternative in selected patients.