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Review
. 2017 Jan;20(Supplement):S11-S18.
doi: 10.4103/0971-9784.197791.

Cannulation strategies in adult veno-arterial and veno-venous extracorporeal membrane oxygenation: Techniques, limitations, and special considerations

Arun L Jayaraman  1 , Daniel Cormican  2 , Pranav Shah  3 , Harish Ramakrishna  4
Affiliations
Review

Cannulation strategies in adult veno-arterial and veno-venous extracorporeal membrane oxygenation: Techniques, limitations, and special considerations

Arun L Jayaraman et al. Ann Card Anaesth. 2017 Jan.

Abstract

Extracorporeal membrane oxygenation (ECMO) refers to specific mechanical devices used to temporarily support the failing heart and/or lung. Technological advances as well as growing collective knowledge and experience have resulted in increased ECMO use and improved outcomes. Veno-arterial (VA) ECMO is used in selected patients with various etiologies of cardiogenic shock and entails either central or peripheral cannulation. Central cannulation is frequently used in postcardiotomy cardiogenic shock and is associated with improved venous drainage and reduced concern for upper body hypoxemia as compared to peripheral cannulation. These concerns inherent to peripheral VA ECMO may be addressed through so-called triple cannulation approaches. Veno-venous (VV) ECMO is increasingly employed in selected patients with respiratory failure refractory to more conventional measures. Newer dual lumen VV ECMO cannulas may facilitate extubation and mobilization. In summary, the pathology being addressed impacts the ECMO approach that is deployed, and each ECMO implementation has distinct virtues and drawbacks. Understanding these considerations is crucial to safe and effective ECMO use.

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Figures

Figure 1
Figure 1
Basic veno-arterial extracorporeal membrane oxygenation configurations. (a) Central veno-arterial extracorporeal membrane oxygenation with the venous cannula exiting the right atrium and the arterial cannula entering the ascending aorta. (b) Peripheral veno-arterial extracorporeal membrane oxygenation with a venous cannula exiting the femoral vein and the arterial cannula entering the femoral artery with the tip in the common iliac artery
Figure 2
Figure 2
Alternative peripheral veno-arterial extracorporeal membrane oxygenation configurations. (a) Veno-veno-arterial extracorporeal membrane oxygenation with two venous drainage cannulas joined by a Y-connector. (b) Veno-arterial-venous extracorporeal membrane oxygenation with an additional venous cannula conveying oxygenating blood. Please note the screw clamps and flow sensors on the two efferent limbs. (c) Upper body cannulation using the right internal jugular vein and right subclavian or axillary artery. (d) A distal perfusion catheter may be used to maintain perfusion distal to the arterial cannula in the ipsilateral lower extremity
Figure 3
Figure 3
Common veno-venous extracorporeal membrane oxygenation configurations. (a) Conventional veno-venous extracorporeal membrane oxygenation, where the tip of the drainage cannula lies at the inferior vena cava-right atria junction and the tip of the return cannula is in the right atrium. (b) Femoral-femoral veno-venous extracorporeal membrane oxygenation, where the tip of the drainage cannula is in the infrahepatic inferior vena cava and the tip of the outflow cannula is in the right atrium. (c) The Avalon Elite® veno-venous extracorporeal membrane oxygenation cannula, with bicaval drainage ports and a return port that directs oxygenated blood toward the tricuspid valve
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References

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