Abstract Introduction Acute limb ischemia is a serious complication of veno-arterial extracorporeal membrane oxygenation (VA ECMO). The impact of pre-existing peripheral arterial disease (PAD) —a marker of systemic vascular dysfunction—on ischemic complications and clinical outcomes during VA ECMO remains unclear. Small single-center studies suggest an increased risk among patients with PAD. We aimed to evaluate whether PAD is associated with a higher risk of VA ECMO-associated acute limb ischemia and to assess its effect on mortality and hospital resource utilization. Methods Using the 2022 Nationwide Readmissions Database, we identified adult hospitalizations requiring VA ECMO using ICD-10-PCS codes. VA ECMO-associated ischemic limb patients were identified using ICD-10-CM codes for acute limb ischemia during the same hospitalization. Peripheral arterial disease (PAD) was defined using ICD-10-CM codes. Baseline comorbidities, in-hospital mortality, length of stay (LOS), total charges, and discharge disposition were compared between ischemic limb patients with and without PAD. Multivariable logistic analysis assessed the association between PAD and limb ischemia, and mortality among ischemic limb patients was compared by PAD status. Results Among 9, 912 VA ECMO hospitalizations, the mean age was 44. 6 years, and 36. 6% were female. PAD was present in 3. 4%, while acute limb ischemia occurred in 10. 3% of the overall cohort. PAD patients had higher rates of acute limb ischemia (17. 3% vs 10. 1%, p 0. 001) and more comorbidities, including DM (50% vs 21%), CKD (32% vs 13%), and ESRD (32% vs 24%) (all p 0. 001). PAD remained independently associated with acute limb ischemia (adjusted OR ≈ 1. 9, p 0. 001). Among patients who developed acute limb ischemia, those with PAD had higher mortality (57. 6% vs 43. 3%, p = 0. 03), more extended hospital stays (41. 6 vs 32. 8 days), and greater total charges (1. 53M vs 1. 19M). Although approximately 77% of VA-ECMO patients were discharged to non-home facilities, limb ischemia and PAD were not independently associated with discharge disposition. Only five patients underwent vascular intervention, which limited the analysis of its potential benefit. Conclusions Our study showed that pre-existing PAD in VA ECMO cohort was independently associated with nearly two-fold higher odds of acute limb ischemia, higher mortality, longer hospitalization, and greater costs. These findings highlight the need for routine vascular screening, early limb monitoring, and individualized perfusion strategies in ECMO patients with PAD. Further studies should explore whether targeted vascular interventions can mitigate ischemic and economic burden in this high-risk population. This abstract is funded by: None
Khan et al. (Fri,) studied this question.