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Review
. 2018 Jun;8(3):372-377.
doi: 10.21037/cdt.2018.01.11.

Management of vascular complications of extra-corporeal membrane oxygenation

Anil K Pillai  1 , Zagum Bhatti  1 , Andrew J Bosserman  1 , Manoj C Mathew  1 , Kaza Vaidehi  2 , Sanjeeva P Kalva  2
Affiliations
Review

Management of vascular complications of extra-corporeal membrane oxygenation

Anil K Pillai et al. Cardiovasc Diagn Ther. 2018 Jun.

Abstract

Extra-corporeal membrane oxygenation (ECMO) is a well-established treatment for cardiopulmonary failure. Based on the requirement for cardiac and or respiratory support different configurations of ECMO circuits are utilized. Vascular complication of ECMO constitutes the most important determinant of treatment outcomes. The complications are primarily related to limb ischemia, vascular injury, hemorrhage, and infection. Endovascular and surgical treatment options are the cornerstone for managing vascular complications of ECMO.

Keywords: Complications; extra-corporeal membrane oxygenation (ECMO); vascular; veno arterial (VA) ECMO; veno-venous (VV) ECMO.

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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
Two ECMO techniques, venous-arterial and venous-venous, are demonstrated here including VA ECMO and VV ECMO (A,B). ECMO, extra-corporeal membrane oxygenation; VA, veno arterial; VV, veno-venous.
Figure 2
Figure 2
Photograph of a femoral VA ECMO cannula with a DPC. VA ECMO, veno arterial extra-corporeal membrane oxygenation; DPC, distal perfusion catheter.
Figure 3
Figure 3
Chest X ray demonstrating a single VV ECMO cannula with displaced tip in the right atrium with recirculation and poor carbon dioxide clearance. VV ECMO, veno-venous extra-corporeal membrane oxygenation.
Figure 4
Figure 4
A 47-year-old female with COPD underwent initiation of VV ECMO using a single cannula from the right internal jugular vein for acute respiratory failure while awaiting lung transplant presents with abdominal pain and drop in hematocrit. An unusual abdominal wall hematoma with active extravasation was discovered on CT (A). Bleeding in these patients may be unpredictable due to their anticoagulation and platelet dysfunction. Angiography (B) shows active extravasation from D-11 and D-12 intercostal arteries. Both arteries were selectively cannulated and successfully embolized with gel foam (not shown). COPD, chronic obstructive pulmonary disease; VV ECMO, veno-venous extra-corporeal membrane oxygenation.
See this image and copyright information in PMC

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