Venovenous extracorporeal membrane oxygenation (ECMO) using a double-lumen cannula

Extracorporeal membrane oxygenation (ECMO) can support neonates with severe respiratory failure. Currently, the most common application of ECMO requires venoarterial access. Venovenous (VV) ECMO is desirable to avoid common carotid artery ligation. However, the best technique of venous access for VV ECMO is not established. Using a single cannula with a double-lumen (DLC) in the right atrium for simultaneous drainage and infusion of blood, VV ECMO provided total respiratory support for six apneic puppies for 3 h each. Mean systemic arterial oxygenation was lower with DLC VV (50 torr) compared to VA ECMO (247 torr), but a physiologic pH (mean 7.34) was maintained on DLC VV bypass. Higher mean bypass flow was required on DLC VV (124 ml/kg/min) compared to VA flow (101 ml/kg/min) because of recirculation of oxygenated blood. The position of the DLC in the right atrium needed to be closely monitored. Hemorrhage was noted in the myocardium after use of DLC VV ECMO.