Axillary Approach for Venoarterial Extracorporeal Membrane Oxygenation Cannulation

Abstract

Extracorporeal membrane oxygenation support (ECMO) is a form of mechanical circulatory support that is used in patients with severe dysfunction of heart or lung or both. Depending on whether it is venovenous or venoarterial support, it can temporarily substitute for circulation and ventilation while the underlying cause is addressed. Traditional approach for cannulation usually involves the femoral vessels. This is due to the easy accessibility, larger lumen of vessels, and physician expertise and training in femoral approach. However, in certain circumstances like critical lower extremity ischemia, crush injury or trauma to lower extremity, and lower extremity infections (like necrotizing fasciitis), this approach is not practical. In these situations, axillary vasculature provides a good substitute for ECMO cannulation.

Keywords: cannulation; extracorporeal membrane oxygenation support; infective endocarditis; mechanical circulatory support; valve replacement surgery; valve surgery.

Figure 1. Electrocardiogram with persistent ventricular arrhythmias despite restoration of blood flow after cardiac catheterization

Figure 2. Chest x-ray with worsening bilateral pulmonary infiltrates

Figure 3. Transthoracic echocardiogram with severely dilated right ventricle (red arrow) and left ventricle (blue arrow) in short axis view

Figure 4. Transesophageal echocardiogram with severe mitral stenosis with elevated gradients across the prosthetic mitral valve

Figure 5. Transesophageal echocardiogram with severe stenosis and vegetation on prosthetic mitral valve (red arrow) and severe aortic stenosis (blue arrow)