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. 2015;7(4):320-6.

Pitfalls in percutaneous ECMO cannulation

L Rupprecht  1 , D Lunz  2 , A Philipp  1 , M Lubnow  3 , C Schmid  1
Affiliations

Pitfalls in percutaneous ECMO cannulation

L Rupprecht et al. Heart Lung Vessel. 2015.

Abstract

Introduction: This observational report depicts typical problems of extracorporeal membrane oxygenation cannulation from a large case series of a single center.

Methods: We analysed our experience with 720 consecutive patients receiving veno-venous or veno-arterial extracorporeal membrane oxygenation focusing on the spectrum of complications occurring in a subset of 159 patients treated with percutaneous veno-arteria extracorporeal membrane oxygenation in our institution between January 2009 to December 2014.

Results: The main problems were: vascular complications or ischemia of the corresponding extremity (leading to surgical revision in 16.9 % of patients); blood loss and/or relocation of cannulas. Hypoxia of the upper body (Harlequin syndrome) occurred in 8.8 % of patients. Cannulation failure and malfunction were infrequent. Careful insertion technique, close surveillance and monitoring are compelling.

Conclusions: As lack of experience is the trigger of many complications, adequate training of cannulation techniques is essential to minimize adverse events.

Keywords: ECMO; cannulation; limb ischemia; percutaneous.

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Conflict of interest statement

Disclosures None declared.

Figures

Figure 1
Figure 1
Correct cannula placement with a distal leg perfusion system for the right femoral artery (arrow).
Table 1
Table 1
Conspicuous events and complications during and after percutaneous cannula placement in 159 patients with venous arterial extracorporeal membrane oxygenation.
Figure 2
Figure 2
Multiple catheter and cannula placement into the femoral vessels.
Figure 3
Figure 3
Inadequate cannula fixation by loosened sutures (left) or far too distant lashing straps (right).
Figure 4
Figure 4
Cannulation of the wrong vessel - arterial cannula in the left femoral vein.
Figure 5
Figure 5
Cannulation of the wrong vessel - venous cannula in the carotid artery.
Figure 6
Figure 6
Dissection of the femoral artery.
Figure 7
Figure 7
Perforation of the inferior caval vein.
Figure 8
Figure 8
Sufficient distance between cannulas in veno-venous ECMO: correct femoro-jugular distance (left); short circuit shunting via side-holes (right).
Figure 9
Figure 9
Abdominal compartment compressing the inferior caval vein.
Figure 10
Figure 10
Harlequin syndrome.
Figure 11
Figure 11
Fracture of a double-lumen venous cannula (Avalon®).
See this image and copyright information in PMC

References

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