[How to Insert the Cannula for Central or Peripheral Venous-arterial Extracorporeal Membrane Oxygenation(VA-ECMO)?]

Gold standard cannulation for peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is from the femoral artery and vein by using ultrasound guided puncture technique percutaneously. The Seldinger technique by using the guide wire is the major approach to place the cannula. Direct cut-down exposure technique is another option if the percutaneous approach is difficult. The size selection of the cannula is also important to get sufficient flow for peripheral VA-ECMO. If the lower limb had ischemia, the extra distal perfusion should be added. Central ECMO by perfusing the ascending aorta and drainage from the right atrium is the emergent option when the circulatory problem had occurred in the intensive care unit( ICU) after cardiac surgery. In patients who cannot come off cardiopulmonary bypass, the ordinary cannulation using the ascending aorta and superior venous cava and inferior venous cava for central ECMO should be continued. Complications associated with VA-ECMO insertion include bleeding, vascular injury, retroperitoneal injury, and hematoma due to accidental puncture, and leg ischemia. There are various approaches to VA-ECMO, and it is important to fully understand and master the characteristics of each ones.