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Review
. 2018 Mar;10(Suppl 5):S616-S623.
doi: 10.21037/jtd.2018.03.83.

Cannulation technique: femoro-femoral

Aidan J C Burrell  1   2 , Joshua F Ihle  1   2 , Vincent A Pellegrino  1   2 , Jayne Sheldrake  1 , Paul T Nixon  1   2
Affiliations
Review

Cannulation technique: femoro-femoral

Aidan J C Burrell et al. J Thorac Dis. 2018 Mar.

Abstract

The cannulation technique used during veno-venous extracorporeal membrane oxygenation (VV ECMO) insertion can have a major impact on a patients' overall outcome. We have developed a technique that aims to combine speed and effectiveness, with minimal risk. The steps include: (I) percutaneous cannulation using the Seldinger technique; (II) ultrasound guided access and positioning of cannulas; (III) femoro-femoral circuit configuration with a later option of high flow; (IV) a no skin cut serial dilation technique; (V) non-suturing securing of cannulas and (VI) a non-surgical manual pressure technique of explantation. The following is a discussion around these techniques and their various advantages and disadvantages.

Keywords: Veno-venous extracorporeal membrane oxygenation (VV ECMO); acute respiratory distress syndrome (ARDS); cannula; ultrasound-guided.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Recirculation during fem-fem VV-ECMO. (A) Inadequate separation of access and return cannulas can lead to high recirculation; (B) Adequate separation of access and return cannulas will reduce recirculation. VV ECMO, veno-venous extracorporeal membrane oxygenation.
Figure 2
Figure 2
Abdominal X-ray showing the longer course of the left-sided femoral cannula.
Figure 3
Figure 3
Two-person technique of serial dilation during fem-fem VV ECMO cannulation. VV ECMO, veno-venous extracorporeal membrane oxygenation.
Figure 4
Figure 4
Ultrasound-guided positioning of the return cannula in the IVC. IVC, inferior venous cava.
See this image and copyright information in PMC

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