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Review
. 2023 Jul;39(Suppl 1):91-100.
doi: 10.1007/s12055-023-01537-0. Epub 2023 Jun 2.

Cannulation strategies for extracorporeal membrane oxygenation

Meganne Nichole Ferrel  1 , Syed Sikandar Raza  1 , Paul Tang  1 , Jonathan Haft  1 , Ashraf Abou El Ala  1
Affiliations
Review

Cannulation strategies for extracorporeal membrane oxygenation

Meganne Nichole Ferrel et al. Indian J Thorac Cardiovasc Surg. 2023 Jul.

Abstract

Extracorporeal membrane oxygenation (ECMO) is a type of extracorporeal life support (ECLS) in which the function of the heart and/or lungs is partially or completely replaced by a portable system that provides prolonged support to critically ill patients with respiratory or cardiac failure. There are two major variants of ECMO: veno-venous (VV) ECMO and veno-arterial (VA) ECMO. VV ECMO replaces the function of the lung in which it uses a cannula to remove venous blood and oxygenates it using the extracorporeal system, and returns the blood to the right atrium to be pumped to the body. VA ECMO is slightly different in that it replaces the function of the heart and lungs by returning oxygenated blood to the aorta. As a therapy for respiratory failure, ECMO minimizes hypoxia, diminishes lung stress and strain, and allows lung protective mechanical ventilation. As a support for acute and terminal heart failure, ECMO reduces preload, increases aortic flow, and allows for end-organ perfusion. Due to its physiological support and advantages, it is used for a variety of chronic and acute support purposes such as bridge therapy for heart/lung transplant, durable ventricular assist devices, and intermediate-term mechanical support postoperatively. Our review gives a broad overview of the two main types of ECMO strategies and their clinical indications, cannulation strategies, unique clinical utility, and their limitations.

Keywords: Cannulation; Cardiothoracic surgery; ECMO.

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Conflict of interest statement

Conflict of interestAll authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Society for Cardiovascular Angiography and Intervention (SCAI) classification for shock [5]
Fig. 2
Fig. 2
Schematic of cannulation of central VA ECMO in a post-cardiotomy setting. Legend: VA, veno-arterial; SVC, superior vena cava; IVC, inferior vena cava; RA, right atrium; RV, right ventricle; PA, pulmonary artery; LA, left atrium; LV, left ventricle; O2, oxygen
Fig. 3
Fig. 3
Schematic of peripheral VA ECMO cannulation via femoral vessels
Fig. 4
Fig. 4
Clinical scenario of Harlequin syndrome (North-South mixing syndrome) in a patient with large anterior wall myocardial infarction after percutaneous intervention on peripheral VA ECMO. Chest X-ray (CXR) indicating severe pulmonary edema (A) with accompanying arterial blood gases (ABGs) and (B) identifying differential oxygen saturation in femoral vessels versus radial artery as depicted in our review. C CXR indicating resolution of differential oxygenation in radial artery and pulmonary edema post-IJ cannula (superior arrow) placement 13 cm from venous cannula (inferior arrow). Legend: pCO2, partial pressure of carbon dioxide; pO2, partial pressure of oxygen
Fig. 5
Fig. 5
Pulmonary edema caused by LV distension after peripheral VA ECMO cannulation (L). Improved after placing a cannula in the left atrium via transseptal puncture (R)
Fig. 6
Fig. 6
RVAD ECMO via a spectrum dual lumen single cannula (with extra drainage side holes in RV as well as RA), providing oxygenation, ventilation, as well as RV support — outflow/PA port is 15 Fr; for the 31-Fr cannula, smaller sizes can be flow limiting. Legend: RVAD, right ventricular assist device; RV, right ventricle; RA, right atrium
See this image and copyright information in PMC

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