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Jianwei Wang,1– 3 Shengshu Wang,1,4 Yang Song,1,2 MingJun Huang,5 Wenzhe Cao,1,2 Shaohua Liu,1,2 Shimin Chen,1,2 Xuehang Li,1,2 Miao Liu,2 Yao He1 1Institute of Geriatrics, The Second Medical Center & National Clinical Research Center for Geriatrics Diseases, Beijing Key Laboratory of Research on Aging and Related Diseases, State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China; 2Graduate School of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China; 3Department of Critical Care Medicine, Puyang People’s Hospital of Henan Province, Puyang, 457000, People’s Republic of China; 4Department of Healthcare, Agency for Offices Administration, Central Military Commission, Beijing, 100082, People’s Republic of China; 5The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People’s Republic of ChinaCorrespondence: Yao He, Institute of Geriatrics, The Second Medical Center & National Clinical Research Center for Geriatrics Diseases, Beijing Key Laboratory of Research on Aging and Related Diseases, State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, People’s Republic of China, Tel +86-37166913114, Email Yaohe_h50@163.comObjective: To investigate the preventive effect of distal perfusion catheters (DPCs) on vascular complications in patients undergoing venous artery extracorporeal membrane oxygenation (VA-ECMO).Methods: Patients who underwent VA-ECMO through a femoral approach in our hospital were included in this study, and they were divided into two groups according to their use of DPC. Clinical indicators were compared between the two groups, including the ECMO running time, intensive care unit (ICU) time, length of hospital stay, ECMO auxiliary results, the incidence of limb ischemia and vascular complications.Results: In total, 250 patients were included in this study, including the DPC group (age: 48 [32– 62] years old, 58.4% male, n = 125) and the non-DPC group (age: 51 [36– 63] years old, 65.6% male, n = 125). The DPC group was less likely to have limb complications than the non-DPC group (6.4% vs 17.6%, P = 0.006), mainly resulting from distal ischemia (4.0% vs 15.2%, P = 0.003) and necrosis (1.6% vs 9.6%, P = 0.006). The ECMO duration had a median of 92.3 (75.7– 109) h in the DPC group and 71.2 (59.4– 82.8) h in the DPC group, with a difference close to the statistical threshold (P = 0.054). There was no significant difference in ICU time or length of hospital stay between the two groups. The multivariate analysis showed that the DPC implantation was negatively associated with limb complications (odds ratio: 0.265, 95% confidence interval: 0.107– 0.657, P = 0.004) after adjustment for confounding factors.Conclusion: Distal perfusion catheter placement might be associated with a decreased risk of vascular complications and limb ischemia in patients undergoing femoral VA-ECMO cannulation. Further randomised studies are still needed to verify its benefit on clinical outcomes.Keywords: distal perfusion catheter, extracorporeal membrane oxygenation, femoral cannulation, osteofascial compartment syndrome, distal ischemia

Additional file 1: Supplemental Figure 1. Participants enrolled and follow-up from September, 2009 to September, 2021 in BECHCS. Supplemental Figure 2. Restricted cubic spline for the association of CVH score with all-cause mortality. Supplemental Figure 3. Subgroup analysis for the association of CVH with all-cause mortality. Supplemental Table 1. Definition of 6 ideal cardiovascular health metrics according to American Heart Association*.