3: Peroneal Nerve Injury Following Peripheral VA-ECMO in a 17-Year-Old Female: Complete Recovery with Ultrasound-Guided Dry Needling

Introduction: Peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in pediatric and young adult patients with refractory cardiogenic shock. While life-saving, femoral cannulation strategies can predispose patients to limb ischemia and peripheral nerve injuries. We present the case of a 17-year-old female with toxic cardiomyopathy who underwent peripheral VA-ECMO following severe cardiogenic shock. Case report: Cannulation involved a right femoral venous drainage cannula (25F), a left femoral arterial return cannula (19F), and an additional 8F distal reperfusion catheter in the left superficial femoral artery. The patient demonstrated rapid cardiac recovery, allowing successful surgical decannulation after 72 hours of support. Following discharge, the patient reported persistent pain in the left leg associated with partial foot drop. Clinical evaluation and nerve conduction studies confirmed a diagnosis of common peroneal nerve injury. The etiology was presumed to be multifactorial, likely related to local ischemia, mechanical compression at the fibular head, and peri-procedural vascular manipulation. Given the neuropathic pain and motor deficit, she was referred to an interventional pain specialist. Management included ultrasound-guided dry needling therapy, administered over eight sessions targeting the affected nerve distribution. The patient experienced progressive symptomatic improvement, culminating in complete recovery of both pain and motor function. Conclusion: This case highlights a rare but significant neurological complication of femoral cannulation in VA-ECMO. While distal perfusion catheters may mitigate limb ischemia, nerve injuries can still occur despite meticulous technique. Furthermore, this report suggests that ultrasound-guided dry needling may serve as a safe, minimally invasive, and effective therapeutic option for post-ECMO peroneal neuropathy.