The Extracorporeal Life Support Organization Maastricht Treaty for Nomenclature in Extracorporeal Life Support. A Position Paper of the Extracorporeal Life Support Organization

Abstract

Extracorporeal life support (ECLS) was developed more than 50 years ago, initially with venoarterial and subsequently with venovenous configurations. As the technique of ECLS significantly improved and newer skills developed, complexity in terminology and advances in cannula design led to some misunderstanding of and inconsistency in definitions, both in clinical practice and in scientific research. This document is a consensus of multispecialty international representatives of the Extracorporeal Life Support Organization, including the North America, Latin America, EuroELSO, South West Asia and Africa, and Asia-Pacific chapters, imparting a global perspective on ECLS. The goal is to provide a consistent and unambiguous nomenclature for ECLS and to overcome the inconsistent use of abbreviations for ECLS cannulation. Secondary benefits are ease of multicenter collaboration in research, improved registry data quality, and clear communication among practitioners and researchers in the field.

Keywords: cannula; extracorporeal circulation; extracorporeal membrane oxygenation; membrane oxygenators; terminology.

Figure 1.

Relationship between ECLS systems, support modes, clinical conditions, and applications. AV = arteriovenous; ECPR = extracorporeal cardiopulmonary resuscitation; EISOR = extracorporeal interval support for organ retrieval; VA = venoarterial; VV = venovenous; VVA = venovenoarterial. Illustration by Jacqueline Schaffer.

Figure 2.

Schematic of (A) venoarterial extracorporeal membrane oxygenation (ECMO), typically used for cardiac failure, and (B) venovenoarterial ECMO, typically used for combined cardiac and respiratory failure, showing common cannulation configurations and direction of blood flow. F_SO₂ = sweep gas inlet oxygen fraction; VA = venoarterial; V_f-A_f = femoral venous drainage to femoral arterial return; V_f-V_jA_f = femoral venous drainage to jugular venous and femoral arterial return; VVA = venovenoarterial. Modified from Figure 1 in Reference . Illustration by Jacqueline Schaffer.

Figure 3.

Schematic of (A) venovenous extracorporeal membrane oxygenation, typically used for respiratory failure with two-site cannulation, and (B) single-site dual-lumen cannulation showing common cannulation configurations and direction of blood flow. (dl) V_j-V = dual-lumen jugular venous drainage to venous return; ECMO = extracorporeal membrane oxygenation; F_SO₂ = sweep gas inlet oxygen fraction; IVC = inferior vena cava; SVC = superior vena cava; V_f-V_j = femoral venous drainage to jugular venous return; VV = venovenous. Modified from Figure 1 in Reference . Illustration by Jacqueline Schaffer.

Figure 4.

Schematic of (A) venovenous extracorporeal carbon dioxide removal (ECCO₂R) and (B) pumpless arteriovenous ECCO₂R, typically used for hypercapnic respiratory failure or lung protection during hypoxemic respiratory failure, showing common cannulation configurations and direction of blood flow. A_f-V_f = femoral arterial drainage to femoral venous return; AV = arteriovenous; (dl) V_j-V = dual-lumen jugular venous drainage to venous return; F_SO₂ = sweep gas inlet oxygen fraction; VV = venovenous. Modified from Figure 1 in Reference . Illustration by Jacqueline Schaffer.