Extracorporeal membrane oxygenation (ECMO) is used as a modified pulmonary or cardiopulmonary bypass technique in those with severe cardiac and/or respiratory failure refractory to conventional ventilatory support and medical intervention 1,3. There are two access paths for extracorporeal life support (ECLS) cannulation, veno-arterial (VA) ECMO and veno-venous (VV) ECMO, which can be performed via surgical cut down or percutaneous insertion.
The ECLS system, as VA ECMO, drains the blood from the right atrium via a femoral or internal jugular venous cannula or in patients with an open chest, directly from the right atrium. The blood is actively pumped through a membrane oxygenator, removing carbon dioxide and adding oxygen. Afterwards, the oxygenated blood is actively pumped into the arterial central system via a cannula placed in the femoral or subclavian artery (closed chest) or directly into the aorta. VA ECLS can provide full cardiopulmonary support with a high blood flow up to 6-7 L/min.
VV ECMO drains blood from the superior vena cava via an internal jugular venous cannula or inferior vena cava via a femoral venous cannula. The blood is pumped via the oxygenator back into the venous system via a femoral venous cannula. A double-lumen cannula, inserted in the internal jugular vein, can be used for venous drainage and return. VV ECMO can provide full or partial extracorporeal pulmonary support with blood flow up to 6 L/min.
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