Abstract
The application of extracorporeal membrane oxygenation (ECMO) for treatment of respiratory and/or cardiac failure has increased over the past decade.1 Expansion of indications and inclusion of higher-risk patients has increased the number of challenging clinical scenarios in which limitations in oxygen delivery with conventional ECMO circuits are encountered during support. In this issue of the JTCVS Techniques, Shah and colleagues2 from the University of Maryland review the use of hybrid and parallel ECMO circuits in clinical scenarios in which standard venoarterial (VA) or venovenous (VV) ECMO circuits fail to provide adequate oxygen delivery or perfusion and provide a number of important management and technical observations and recommendations.
Highlights
The application of extracorporeal membrane oxygenation (ECMO) for treatment of respiratory and/or cardiac failure has increased over the past decade.1 Expansion of indications and inclusion of higher-risk patients has increased the number of challenging clinical scenarios in which limitations in oxygen delivery with conventional ECMO circuits are encountered during support
With respect to patients supported with VA ECMO who experience upper body hypoxia due to concomitant respiratory failure and competition of ECMO flow with native cardiac output, the authors describe the value of the venoarteriovenous ECMO circuit
An additional venous cannula positioned in the right side of the circulatory system returns oxygenated blood from the ECMO circuit to the heart to reduce the proportion of deoxygenated blood being ejected by the native heart to resolve the upper body hypoxia
Summary
The application of extracorporeal membrane oxygenation (ECMO) for treatment of respiratory and/or cardiac failure has increased over the past decade.[1] Expansion of indications and inclusion of higher-risk patients has increased the number of challenging clinical scenarios in which limitations in oxygen delivery with conventional ECMO circuits are encountered during support. The authors emphasize 2 principals: that clinical situations necessitating hybrid or parallel circuits are infrequent and that optimal patient management and technical application of conventional ECMO circuits is paramount before considering hybrid or parallel ECMO circuits. From the Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
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