Long venous cannula on the arterial position for VA-ECMO

Area of Science:

• Cardiovascular Medicine
• Pediatric Critical Care
• Extracorporeal Life Support

Background:

• Managing peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) presents challenges including differential hypoxia and arterial deoxygenation.
• Optimizing oxygen delivery to the aortic arch branches and coronary arteries is crucial for patient outcomes.

Observation:

• A novel VA-ECMO cannulation strategy was developed.
• This technique involves bicaval drainage via the femoral vein and retrograde ECMO flow.
• A multi-stage venous cannula is inserted into the femoral artery, with its tip positioned in the proximal descending thoracic aorta.

Findings:

• The described VA-ECMO approach was successfully applied in two pediatric cases.
• A 15-year-old female with combined cardiorespiratory failure and a 12-year-old male with acute cardiac failure were treated.
• This method facilitates improved perfusion to the aortic arch and coronary arteries.

Implications:

• This cannulation technique offers a potential solution for improving cerebral and myocardial perfusion during peripheral VA-ECMO.
• It may enhance management strategies for pediatric patients with complex cardiorespiratory failure.
• Further research is warranted to validate the long-term efficacy and safety of this approach.