Skip to main content

Advertisement

SpringerLink
Log in

Cannulation strategies for extracorporeal membrane oxygenation

  • Review Article
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Lafç G, Budak AB, Yener AÜ, Cicek  OF. Use of extracorporeal membrane oxygenation in adults. Heart Lung Circ. 2014;23:10–23.

    Article  PubMed  Google Scholar 

  2. Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, et al. Predicting survival after ECMO for refractory cardiogenic shock: the Survival After Veno-Arterial-ECMO (SAVE)-score. Eur Heart J. 2015;36:2246–56. https://doi.org/10.1093/eurheartj/ehv194.

    Article  CAS  PubMed  Google Scholar 

  3. Fletcher-Sandersjöö A, Frenckner B, Broman M. A single-center experience of 900 interhospital transports on extracorporeal membrane oxygenation. Ann Thorac Surg. 2019;107:119–27. https://doi.org/10.1016/j.athoracsur.2018.07.040.

    Article  PubMed  Google Scholar 

  4. Naidu SS, Baran DA, Jentzer JC, Hollenberg SM, van Diepen S, Basir MB, et al. SCAI SHOCK Stage Classification Expert Consensus update: a review and incorporation of validation studies: This statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021. J Am Coll Cardiol. 2022;79:933–46. https://doi.org/10.1016/j.jacc.2022.01.018.

    Article  PubMed  Google Scholar 

  5. Baran DA, Grines CL, Bailey S, Burkhoff D, Hall SA, Henry TD, et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock. Catheter Cardiovasc Interv. 2019;94:29–37.

    PubMed  Google Scholar 

  6. Telukuntla KS, Estep JD. Acute mechanical circulatory support for cardiogenic shock. Methodist Debakey Cardiovasc J. 2020;16:27–35. https://doi.org/10.14797/mdcj-16-1-27.

  7. Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol. 2014;63:2769–78.

  8. van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation. 2017;136:e232–68.

  9. ELSO Adult Cardiac Failure Supplement to the ELSO General Guidelines Extracorporeal Life Support Organization (ELSO) Guidelines for Adult Cardiac Failure.; 2013. https://www.elso.org/Portals/0/IGD/Archive/FileManager/e76ef78eabcusersshyerdocumentselsoguidelinesforadultcardiacfailure1.3.pdf. Accessed 26 Aug 2018.

  10. Extracorporeal Life Support Organization - ECMO and ECLS >about us >overview. https://www.elso.org/AboutUs/Overview.aspx. Accessed 21 Aug 2017.

  11. Feldman D, Pamboukian SV, Teuteberg JJ,  Birks E, Lietz K, Moore SA, et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013;32:157–87.

    Article  PubMed  Google Scholar 

  12. ELSO ECPR Supplement to the ELSO General Guidelines Extracorporeal Life Support Organization (ELSO) Guidelines for ECPR Cases.;2013. https://www.elso.org/Portals/0/IGD/Archive/FileManager/6713186745cusersshyerdocumentselsoguidelinesforecprcases1.3.pdf. Accessed 26 Aug 2018.

  13. Soleimani B, Pae WE. Management of left ventricular distension during peripheral extracorporeal membrane oxygenation for cardiogenic shock. Perfusion. 2012;27:326–31.

    Article  CAS  PubMed  Google Scholar 

  14. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al; CESAR trial collaboration. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomized controlled trial. Lancet. 2009;374:1351–63.

  15. Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, et al. Extracorporeal membrane oxygenation for 2009 influenza A (H1N1) acute respiratory distress syndrome. JAMA. 2009;302:1888–95.

  16. Peek GJ, Clemens F, Elbourne D, Firmin R, Hardy P, Hibbert C, et al. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure. BMC Health Serv Res. 2006;6:163. https://doi.org/10.1186/1472-6963-6-163.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Eckman PM, Katz JN, El Banayosy A, Bohula EA, Sun B, van Diepen S. Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock. An introduction for the busy clinician. Circulation. 2019;140:2019–37.

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, 48197, USA

    Meganne Nichole Ferrel, Syed Sikandar Raza, Paul Tang, Jonathan Haft & Ashraf Abou El Ala

Authors
  1. Meganne Nichole Ferrel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Syed Sikandar Raza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jonathan Haft
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ashraf Abou El Ala
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AAA contributed to the conception or design of the work. MNF and SSR contributed to drafting the article. AAA, JH, and PT contributed to the critical revision of the article. All authors contributed to the final approval of the version to be published.

Corresponding author

Correspondence to Ashraf Abou El Ala.

Ethics declarations

Ethics committee approval

Not applicable as it is a review article and no new research was carried out.

Informed consent

All appropriate consent was obtained for inclusion of patient data in this review.

Research involving human participants and/or animals

Research involving human and/or animal participants was not conducted.

Conflict of interest

All authors report no conflict of interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Meganne Nichole Ferrel and Syed Sikandar Raza are co-first authors.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferrel, M.N., Raza, S.S., Tang, P. et al. Cannulation strategies for extracorporeal membrane oxygenation. Indian J Thorac Cardiovasc Surg 39 (Suppl 1), 91–100 (2023). https://doi.org/10.1007/s12055-023-01537-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-023-01537-0

Keywords

Search

Navigation