VA Extracorporeal Membrane Oxygenation Research Articles

Venoarterial extracorporeal membrane oxygenation support for two patients after pulmonary thromboendarterectomy

cardiopulmonary bypass (CPB) after PTE secondary to reperfusion injury and massive pulmonary hemorrhage, which are the main causes of in-hospital deaths. Extracorporeal membrane oxygenation (ECMO) may be utilized as a treatment for such critically ill patients, providing basic life support and time for recovery. Recent reports are now suggesting support ECMO using the venoarterial mode (VA ECMO). Here we report two successful cases of VA ECMO in two patients who were also critically ill after PTE. The patients gave their written consent for the publication of this article. In the first case, a 49-yr-old female presented with recurrent syncope and shortness of breath lasting for one month after being immobilized for two months due to a fracture of the left patella. Transthoracic echocardiography (2D TTE) showed an enlarged right ventricle, a normal-sized left ventricle, and right ventricular systolic pressure (RVSP) of 87 mmHg. Cardiac magnetic resonance imaging showed considerable thrombus extending from the main pulmonary artery to the segmental pulmonary arteries. Right-heart catheterization indicated severe pulmonary arterial hypertension with a systolic pulmonary arterial pressure of 86/37 mmHg (mean, 50 mmHg). Thromboendarterectomy was performed under ten minutes of deep hypothermic circulatory arrest (DHCA). The aortic cross-clamping time was 65 min. The pulmonary arterial pressure on weaning from CPB was equal to the pressure of the systemic circulation, while the volume of blood drainage from the tracheal catheter was greater than 400 mL, hence, the patient was continued on CPB. Bleeding was controlled during CPB; however, the patient could not be weaned from it even after an intervening period. Thus, VA ECMO was established through the femoral artery and vein, respectively, in the operating room to wean her from CPB. The VA ECMO flow rate was maintained at *2.5 Lmin -1 , pulmonary arterial

A Review of Venovenous and Venoarterial Extracorporeal Membrane Oxygenation in Neonates and Children

The use of extracorporeal membrane oxygenation (ECMO) has increased since its inception. As this modality gained wider acceptance, its application in a variety of disease states has increased. The initial use of ECMO required cannulation of both the carotid artery and internal jugular vein (VA ECMO). Ligation of the carotid artery and concern regarding potential long-term sequelae prompted the development of the single cannula venous only (VV ECMO) technique. Various reports in the literature have compared VV ECMO and VA ECMO. We present a review of the literature with regard to both physiology and clinical application.

Venovenous extracorporeal membrane oxygenation (ECMO) using a double-lumen cannula.

Extracorporeal membrane oxygenation (ECMO) can support neonates with severe respiratory failure. Currently, the most common application of ECMO requires venoarterial access. Venovenous (VV) ECMO is desirable to avoid common carotid artery ligation. However, the best technique of venous access for VV ECMO is not established. Using a single cannula with a double-lumen (DLC) in the right atrium for simultaneous drainage and infusion of blood, VV ECMO provided total respiratory support for six apneic puppies for 3 h each. Mean systemic arterial oxygenation was lower with DLC VV (50 torr) compared to VA ECMO (247 torr), but a physiologic pH (mean 7.34) was maintained on DLC VV bypass. Higher mean bypass flow was required on DLC VV (124 ml/kg/min) compared to VA flow (101 ml/kg/min) because of recirculation of oxygenated blood. The position of the DLC in the right atrium needed to be closely monitored. Hemorrhage was noted in the myocardium after use of DLC VV ECMO.