Abstract
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO), at its most fundamental level, consists of an oxygenator, pump, inflow, and outflow. However, these simple components can be used to construct much more complicated circuits that can support a variety of physiologic functions. Venovenous (VV) ECMO can support patients with stable hemodynamics who require respiratory support beyond what standard ventilator techniques can provide. These patients frequently are diagnosed with acute respiratory distress syndrome (ARDS). Venoarterial (VA) ECMO not only maintains the respiratory support provided by VV ECMO, but provides hemodynamic support as well. 1 Napp LC Kühn C Hoeper MM et al. Cannulation strategies for percutaneous extracorporeal membrane oxygenation in adults. Clin Res Cardiol. 2016; 105: 283-296 Crossref PubMed Scopus (123) Google Scholar Although these two traditional configurations are sufficient to support most patients requiring ECMO, patients exist who require more complex circulatory support tailored to their individual physiologic condition. Additional cannulation sites can be used to support circulatory function, creating triple cannulation circuits, including venoarteriovenous (V-AV) or venovenoarterial (VV-A) ECMO. For example, these configurations are useful in cases of upper body hypoxia or insufficient drainage from the original venous cannulation. 1 Napp LC Kühn C Hoeper MM et al. Cannulation strategies for percutaneous extracorporeal membrane oxygenation in adults. Clin Res Cardiol. 2016; 105: 283-296 Crossref PubMed Scopus (123) Google Scholar Additionally, temporary left ventricular assist devices (LVADs) and right ventricular assist devices that also provide oxygenation (OxyRVADs) can support patients with diminished left or right heart function. 2 Ando M Garan AR Takayama H et al. A continuous-flow external ventricular assist device for cardiogenic shock: Evolution over 10 years. J Thorac Cardiovasc Surg. 2018; 156: 157-165 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar In this case, the authors demonstrate how a complex and evolving clinical picture can necessitate the use of multiple different modes of ECMO support.
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