Vascular access for extracorporeal life support: tips and tricks

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Mechanical Circulatory Support

Background:

• Extracorporeal life support (ECLS) provides temporary mechanical support for cardiopulmonary function.
• ECLS encompasses various techniques like venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO).
• Vascular access is critical for ECLS efficacy in thoracic surgery and lung transplantation.

Purpose of the Study:

• To review ECLS techniques used in thoracic surgery and lung transplantation.
• To detail the rationale behind different ECLS configurations and vascular access.
• To guide evidence-based selection of ECLS strategies.

Main Methods:

• Review of current ECLS techniques in thoracic surgery and lung transplantation.
• Analysis of vascular access strategies for VV and VA ECMO.
• Discussion of extracorporeal CO2 removal (ECCO2R) devices.

Main Results:

• VV ECMO is standard for lung support, requiring peripheral access; configuration depends on oxygen needs and ambulatory strategy.
• Central VA ECMO in lung transplantation reduces complications compared to cardiopulmonary bypass.
• Femoro-femoral VA ECMO provides circulatory support but may not adequately oxygenate the brain and heart.

Conclusions:

• ECLS selection in thoracic surgery is increasingly evidence-based.
• Appropriate vascular access is paramount for successful ECLS implementation.
• Advancements in ECLS technology enhance patient outcomes in thoracic procedures and lung transplantation.