PS44 Skin complications and psychological wellbeing following femoral extracorporeal membrane oxygenation: a quality improvement project

Abstract

Extracorporeal membrane oxygenation (ECMO) requires a large femoral cannula secured to the thigh, carrying risks such as infection, bleeding and long-term scarring. Fixation practices vary widely, with no guideline-supported best method. Visible treatment-related changes can contribute to post-intensive care syndrome, including post-traumatic stress disorder, anxiety and depression. With no prior research on ECMO-related skin complications, this project aims to explore patient-reported skin complications secondary to ECMO and their psychological impact. We provide preliminary evidence to inform skin-sparing fixation strategies. A single-centre retrospective review of adults receiving femoral ECMO (January 2024 to January 2025) was conducted. Patients who had survived were interviewed via telephone about intensive care unit-associated skin complications occurring during admission and persisting after discharge, ECMO-related scarring, scar location, scar ‘bother’ score (1–10) and any associated psychological effects. Fourteen patients were interviewed (six male, eight female). Significant scarring was common (12 of 14, 86%): 33% reported irregular or hypertrophic scars and 33% reported infected or poorly healing wounds. Groin scars were reported by 86% and thigh (fixation-site) scarring by 71%. Female patients reported higher bother scores for groin (6.8 vs. 0.66) and thigh scars (6 vs. 2.14) than male patients. Negative mental health effects were reported by 67%, especially women (88%), attributing to negative body image, visibility to others and triggering unwanted memories. These findings highlight a significant burden of ECMO-related skin complications, supporting existing literature linking visible treatment-related scars with adverse mental health outcomes, particularly in female patients. The complications reported reflect concerns of increased infection and scarring risks with the suture-only fixation currently used in this centre. In vitro ECMO studies suggest tissue adhesives offer comparable strength while reducing bacterial migration and skin injury, supporting evaluation of alternative or hybrid skin-sparing fixation strategy. Limitations of this study include the small sample size, single-centre design and retrospective telephone recall. Future work should compare skin burden from suture vs. adhesive-based fixation and incorporate established scar-prevention measures with early psychological support for higher-risk groups.