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Cannulation for ECMO
Pranya Sakiyalak, MD FACS Faculty of Medicine Siriraj Hospital
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Faculty of Medicine Siriraj Hospital
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Cannulation • The establishment and maintenance of adequate
vascular access is essential for ECMO • For each modality, different kinds and sizes of
cannulae can be used
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Guidelines for Cannula size
Weight (Kg) Venous cannula Arterial cannula
2-4 8-14 8-10
5-15 15-19 12-15
16-20 19-21 15-17
21-35 21-23 17-19
35-60 23 19-21
>60 23 21
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Veno-Arterial vs Veno-Venous ECMO
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Veno-Arterial ECMO • Peripheral cannulation
• Femoral vein –femoral artery • Femoral vain-axillary artery • Internal jugular vein -carotid artery • Internal jugular vein – axillary artery
• Central cannulation • Aorta-right atriam • Aorta-bicaval
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Peripheral cannulation •Percutaneous technique •Semi open technique •Open technique
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Percutaneous cannulation
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Percutaneous technique •Seldinger technique •Emergency situation •Risk of vascular complication
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Percutaneous cannulas
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Femoral vessels
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Outcomes of percutaneous femoral cannulation for venoarterial extracorporeal membrane oxygenation support • N=15 in 2 years • Cardiac arrest (n=9, 60%) • Cardiogenic shock (n=4, 27%) • Acute respiratory failure (n=2, 13%) • Mean support 4.9 days • Wean of 53% • 53% 30 days motality • 47% Complication (2 infection, 5 vascular)
Eur Heart J Acute Cardiovasc Care. Jun 2012; 1(2): 111–114.
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Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support • January 2005 to December 2009 •174 patients 143 VA (82%) 31 VV (18%) •17 (10%) vascular complication
Ann Thorac Surg. 2011 Aug;92(2):626-31.
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Ultrasound Guided Femoral Cannulation and Percutaneous Perfusion of the Distal Limb for VA ECMO
• Ultrasound to locate superficial femoral artery • Seldinger technique with U/S guided • Distal limb perfusion catheter inserted
Journal of Cardiac Surgery Volume 29, Issue 3, pages 427–429, May 2014
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Late vascular complications after extracorporeal membrane oxygenation support. • 1998-2004 • 174 patients • Hospital survival was 57.3%. • 12 survivors (12.2%) experienced late vascular complications • local stenosis at the former arterial cannulation site
Ann Thorac Surg. 2006 Mar;81(3):892-5.
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Pediatric VA ECMO
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Algorhytm for pediatric ECMO cannulation
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Semi-open technique
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Open Technique
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Side arm graft for fem ECMO
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Axillary artery cannulation
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Axillary artery cannulation
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Carotid artery – Internal jugular vein cannulation
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Central cannulation • Better drainage • Oxygenated blood perfuse
ascending aorta • Post cardiotomy • Peripheral vascular disease
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LV vent
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Veno-venous ECMO cannlation
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Veno-venous ECMO •Femero-femoral •Internal jugular – femoral •Internal jugular (Dual lumen catheter)
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Fem-fem venovenous ECMO
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IJ-Fem VV ECMO
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IJ-Fem VV ECMO
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Dual lumen venovenous catheter
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Optimum positioning
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Badness
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Dual lumen VV ECMO
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Thank You
Thank You