Beyond Venoarterial and Venovenous Extracorporeal Membrane Oxygenation: Novel Cannulation Strategies

Extracorporeal membrane oxygenation (ECMO) is a means of supporting the heart, lungs, or both when more conventional therapy fails to achieve appropriate physiologic endpoints.

The majority of ECMO configurations fall into 2 main categories: venovenous ECMO (VV-ECMO) and venoarterial ECMO (VA-ECMO). While these 2 configurations are suitable for the majority of patients, specific patient characteristics or acute pathophysiology may benefit more from alternative cannulation strategies. Modifications of VV-ECMO and VA-ECMO such as venoarterial-venous (VAV-ECMO) and venovenous-arterial ECMO (VV-A ECMO) are well known, but novel strategies are emerging that merit discussion.
 

Four alternate strategies will be discussed, with accompanying literature, that may be beneficial in certain instances. Parallel VV-ECMO circuits, veno-venopulmonary arterial ECMO (V-VP ECMO), left atrial–venoarterial ECMO (LAVA-ECMO), and ProtekDuo left ventricular (LV) apical cannulation will be discussed.

Cardiothoracic and intensive care anesthesiologists will often be called on to be a part of cannulation, imaging, and management for these patients; thus, it is important to develop an understanding of these technologies. In what follows, succinct summaries and considerations for a number of less frequently used mechanical circulatory support (MCS) strategies will be provided.