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Ann Card Anaesth. 2017 Jan;20(Supplement):S11-S18. doi: 10.4103/0971-9784.197791.

Cannulation strategies in adult veno-arterial and veno-venous extracorporeal membrane oxygenation: Techniques, limitations, and special considerations.

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Department of Anesthesiology, Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic; Department of Critical Care Medicine, Mayo Clinic, Arizona, USA.
Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Allegheny General Hospital, Pennsylvania, USA.
Department of Anesthesiology, Virginia Commonwealth University, Virginia, USA.
Department of Anesthesiology, Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Arizona, USA.


Extracorporeal membrane oxygenation (ECMO) refers to specific mechanical devices used to temporarily support the failing heart and/or lung. Technological advances as well as growing collective knowledge and experience have resulted in increased ECMO use and improved outcomes. Veno-arterial (VA) ECMO is used in selected patients with various etiologies of cardiogenic shock and entails either central or peripheral cannulation. Central cannulation is frequently used in postcardiotomy cardiogenic shock and is associated with improved venous drainage and reduced concern for upper body hypoxemia as compared to peripheral cannulation. These concerns inherent to peripheral VA ECMO may be addressed through so-called triple cannulation approaches. Veno-venous (VV) ECMO is increasingly employed in selected patients with respiratory failure refractory to more conventional measures. Newer dual lumen VV ECMO cannulas may facilitate extubation and mobilization. In summary, the pathology being addressed impacts the ECMO approach that is deployed, and each ECMO implementation has distinct virtues and drawbacks. Understanding these considerations is crucial to safe and effective ECMO use.

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