Innovative dual-pump regulation in veno-arteriovenous extracorporeal membrane oxygenation: A Single-center experience

To evaluate the safety and efficacy of veno-arteriovenous extracorporeal membrane oxygenation (V-AV ECMO) with a secondary centrifugal pump to control blood flow in return pathways as an alternative to the conventional Hoffman clamp.

We conducted a retrospective review of all adult patients who underwent V-AV ECMO in our hospital from January 1, 2022, to December 31, 2023. Data, including demographic characteristics, comorbidities, and ECMO-specific information, were systematically extracted from electronic medical records.

Five patients, three (60 %) of whom were male, underwent V-AV ECMO. Four patients were initially placed on veno-venous extracorporeal membrane oxygenation (V-V ECMO), and one was placed on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). The mean duration of V-AV ECMO support was 14.4 ± 11.4 days. Ventilator support was reduced, and fewer vasoactive drugs were administrated. Hemoglobin and platelets tended to decrease in all five patients, but D-dimer did not increase. No patients experienced active bleeding, and one patient developed oxygenator thrombosis. Two patients survived to discharge.

V-AV ECMO using a secondary centrifugal pump is feasible and likely safe without increasing the risk of ECMO-related complications such as hemolysis, thrombocytopenia, blood clot formation, or clotting factor consumption. Future prospective studies are warranted to validate these findings and optimize ECMO management protocols.