Abstract
The establishment of ECMO support could be achieved through intrathoracic or extrathoracic cannulation strategies. Central cannulation requires a surgical approach, a sternotomy, and the cannulation of the right atrium and the ascending aorta. The features listed above make the central cannulation the best approach for patients with postcardiotomy complications. Such a cannulation strategy allows the best venous drainage and an anterograde blood flow in ascending aorta; it is though related to important complications such as bleeding and mediastinitis. In case of peripheral cannulation, it is necessary to choose among several sites: femoral vessels, axillary vessels, and cervical vessels are the most used ones. Peripheral vessel cannulation could be achieved either by percutaneous procedures or surgical incisions through an open approach with different techniques (direct cannulation or cannulation with side graft), a semi-Seldinger, or a full Seldinger method. The surgical approach allows the visualization of the vessels, the direct placement of the cannulas, and the control of possible complications. Therefore, it is recommended if immediate support is needed or if a peripheral vascular disease is suspected. Also a mixed central/peripheral cannulation approach is possible. The best cannulation technique should be chosen on the basis of patients and the clinical settings. Moreover, it is necessary to assess benefits and risks of the selected options to pick the best site and strategy of the cannulation.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support. Extracorporeal Life Support Organization, Version 1.3 November 2013, Ann Arbor, MI, USA. HYPERLINK http://www.elsonet.org. Accessed on 27 jan 2014
Marasco SF, Lukas G, McDonald M, McMillan J, Ihle B (2008) Review of ECMO (Extra Corporeal Membrane Oxygenation) support in critically ill adult patients. Heart Lung Circ 17S:S41–S47
Kanji HD, Schulze CJ, Oreopoulos A, Lehr EJ, Wang W, MacArthur RM (2010) Peripheral versus central cannulation for extracorporeal membrane oxygenation: a comparison of limb ischemia and transfusion requirements. Thorac Cardiovasc Surg 58(8):459–462
Vander Salm TJ (1997) Prevention of lower extremity ischemia during cardiopulmonary bypass via femoral cannulation. Ann Thorac Surg 63:251–252
Bürkle MA, Sodian R, Kaczmarek I, Weig T, Frey L, Irlbeck M, Dolch ME (2012) Arterial chimney graft cannulation for interventional lung assist. Ann Thorac Surg 94(4):1335–1337
Jackson KW, Timpa J, McIlwain RB, O’Meara C, Kirklin JK, Borasino S, Alten JA (2012) Side-arm grafts for femoral extracorporeal membrane oxygenation cannulation. Ann Thorac Surg 94(5):e111–e112
Demertzis S, Carrel T (2011) Rapid peripheral arterial cannulation for extracorporeal life support with unimpaired distal perfusion. J Thorac Cardiovasc Surg 141:1080–1081
Lamb KM, Hirose H, Cavarocchi NC (2013) Preparation and technical considerations for percutaneous cannulation for veno-arterial extracorporeal membrane oxygenation. J Card Surg 28(2):190–192
Stulak JM, Dearani JA, Burkhart HM, Barnes RD, Scott PD, Schears GJ (2009) ECMO cannulation controversies and complications. Semin Cardiothorac Vasc Anesth 13(3):176–182
Field ML, Al-Alao B, Mediratta N, Sosnowski A (2006) Open and closed chest extrathoracic cannulation for cardiopulmonary bypass and extracorporeal life support: methods, indications, and outcomes. Postgrad Med J 82:323–331
Bisdas T, Beutel G, Warnecke G, Hoeper MM, Kuehn C, Haverich A, Teebken OE (2011) Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support. Ann Thorac Surg 92(2):626–631
Huang SC, Yu HY, Ko WJ, Chen YS (2004) Pressure criterion for placement of distal perfusion catheter to prevent limb ischemia during adult extracorporeal life support. J Thorac Cardiovasc Surg 128:776–777
Gander JW, Fisher JC, Reichstein AR, Gross ER, Aspelund G, Middlesworth W, Stolar CJ (2010) Limb ischemia after common femoral artery cannulation for venoarterial extracorporeal membrane oxygenation: an unresolved problem. J Pediatr Surg 45(11):2136–2140
Kasirajan V, Simmons I, King J, Shumaker MD, DeAnda A, Higgins RS (2002) Technique to prevent limb ischemia during peripheral cannulation for extracorporeal membrane oxygenation. Perfusion 17(6):427–428
Russo CF, Cannata A, Vitali E, Lanfranconi M (2009) Prevention of limb ischemia and edema during peripheral venoarterial extracorporeal membrane oxygenation in adults. J Card Surg 24:185–187
Schachner T, Bonaros N, Bonatti J, Kolbitsch C (2008) Near infrared spectroscopy for controlling the quality of distal leg perfusion in remote access cardiopulmonary bypass. Eur J Cardiothorac Surg 34(6):1253–1254
Spurlock DJ, Toomasian JM, Romano MA, Cooley E, Bartlett RH, Haft JW (2012) A simple technique to prevent limb ischemia during veno-arterial ECMO using the femoral artery: the posterior tibial approach. Perfusion 27(2):141–145
Kimura N, Kawahito K, Ito S, Murata S, Yamaguchi A, Adachi H, Ino T (2005) Perfusion through the dorsalis pedis artery for acute limb ischemia secondary to an occlusive arterial cannula during percutaneous cardiopulmonary support. J Artif Organs 8(3):206–209
Le Guyader A, Lacroix P, Ferrat P, Laskar M (2006) Venous leg congestion treated with distal venous drainage during peripheral extracorporeal membrane oxygenation. Artif Organs 30(8):633–635
Merin O, Silberman S, Brauner R, Munk Y, Shapira N, Falkowski G, Dzigivker I, Bitran D (1998) Femoro-femoral bypass for repeat open-heart surgery. Perfusion 13:455–459
Greason KL, Hemp JR, Maxwell JM, Fetter JE, Moreno-Cabral RJ (1995) Prevention of distal limb ischemia during cardiopulmonary support via femoral cannulation. Ann Thorac Surg 60(1):209–210
Bichell DP, Balaguer JM, Aranki SF, Couper GS, Adams DH, Rizzo RJ, Collins JJ Jr, Cohn LH (1997) Axilloaxillary cardiopulmonary bypass: a practical alternative to femorofemoral bypass. Ann Thorac Surg 64(3):702–705
Schmidt M, Bréchot N, Hariri S, Guiguet M, Luyt CE, Makri R, Leprince P, Trouillet JL, Pavie A, Chastre J, Combes A (2012) Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Clin Infect Dis 55(12):1633–1641
Navia JL, Atik FA, Beyer EA, Ruda Vega P (2005) Extracorporeal membrane oxygenation with right axillary artery perfusion. Ann Thorac Surg 79(6):2163–2165
Gates JD, Bichell DP, Rizzo RJ, Couper GS, Donaldson MC (1996) Thigh ischemia complicating femoral vessel cannulation for cardiopulmonary bypass. Ann Thorac Surg 61:730–733
Baribeau YR, Westbrook BM, Charlesworth DC (1999) Axillary cannulation: first choice for extra-aortic cannulation and brain protection. J Thorac Cardiovasc Surg 118:1153–1154
Sabik JF, Nemeh H, Lytle BW, Blackstone EH, Gillinov AM, Rajeswaran J, Cosgrove DM (2004) Cannulation of the axillary artery with a side graft reduces morbidity. Ann Thorac Surg 77(4):1315–1320
Chamogeorgakis T, Lima B, Shafii AE, Nagpal D, Pokersnik JA, Navia JL, Mason D, Gonzalez-Stawinski GV (2013) Outcomes of axillary artery side graft cannulation for extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 145(4):1088–1092
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer-Verlag Italia
About this chapter
Cite this chapter
Formica, F., Mariani, S., Paolini, G. (2014). Surgical Cannulation: Indication, Technique, and Complications. In: Sangalli, F., Patroniti, N., Pesenti, A. (eds) ECMO-Extracorporeal Life Support in Adults. Springer, Milano. https://doi.org/10.1007/978-88-470-5427-1_5
Download citation
DOI: https://doi.org/10.1007/978-88-470-5427-1_5
Published:
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-5426-4
Online ISBN: 978-88-470-5427-1
eBook Packages: MedicineMedicine (R0)