Cannula-Associated Deep Vein Thrombosis After Extracorporeal Life Support: A Prospective Diagnostic Study

<b>Background:</b> Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), serves as a major complication in critically ill patients receiving extracorporeal life support (ECLS). The primary aim of the study was to systematically determine the prevalence of cannula-associated DVT following ECLS in a mixed adult ICU population. <b>Methods:</b> In this prospective diagnostic study, performed at two ICUs at a tertiary university hospital, we included 101 patients undergoing ECLS between 2016 and 2021. DVT was assessed by vascular ultrasound within 72 h after decannulation or through post-mortem examination. PE was identified by computed tomography when clinically indicated or through post-mortem examination. Both univariate analysis and multivariable logistic regression were used to evaluate risk factors. <b>Results:</b> The overall prevalence of DVT was 35%, and PE was found in 9% of patients. PE was significantly more frequent in patients with DVT compared to those without DVT (23% vs. 2%, <i>p</i> < 0.001). Logistic regression suggests venovenous configuration as an independent risk factor for DVT compared with venoarterial ECLS (OR = 0.12, 95% CI: 0.04-0.39, <i>p</i> = 0.0004). There were no significant differences in coagulation parameters, including anticoagulation target values, in patients with and without DVT. <b>Conclusions:</b> This study reveals a considerable prevalence of DVT in patients following ECLS, with VV configuration emerging as a considerable risk factor. PE was common, underscoring the need for routine screening protocols and tailored thromboprophylaxis in this population.