Controlled flow diversion in hybrid venoarterial–venous extracorporeal membrane oxygenation

Abstract

Non-invasive monitoring of flow rates within the supplying cannulae of VAV-ECMO and the use of partial occlusion for venous-supplying cannula enable individualized patient management and effective weaning from VAV-ECMO.

Strategies for Left Ventricular Decompression During Venoarterial Extracorporeal Membrane Oxygenation - A Narrative Review

“…This may be a single-lumen return cannula, or a double-lumen Avalon Elite cannula, which allows for bicaval drainage and right atrial return, with minimal recirculation between inflow and outflow ports. 103 Cakici et al 105 reviewed data from 9 patients converted from VA-ECMO to VAV-ECMO for development of Harlequin syndrome during support for primary cardiogenic shock complicated by respiratory failure. Flow sensors and occluder devices were used to control differential flow rates via the return cannulas.…”

Monitoring of adult patient on venoarterial extracorporeal membrane oxygenation in intensive care medicine

“…In an acute medical setting peripheral cannulation of inguinal vessels is preferred, also known as femo-femoral cannulation. Draining cannula is positioned via femoral vein (19)(20)(21)(22)(23) in the area of the right atrium and the back leading cannula is placed via femoral arteria in iliac arteria (15)(16)(17)(18)(19) (5). Due to cannulation strategy a right ventricular release is achieved as well as an adequate perfusion of visceral organs.…”

“…In case of "Harlequin syndrome", e.g., due to combined cardiac and respiratory failure, ECLS can be combined with VV ECMO, called veno-arterial-venous ECMO (VAV ECMO) (21). For this purpose a second venous cannula is placed via right internal jugular vein into superior caval (VCS) vein.…”

Intensivmedizinisches Monitoring der extrakorporalen Herz-Kreislauf- und Lungenunterstützung

“…Wenn möglich, sollte die Gefäßpunktion sowie die Vorführung der Seldinger-Drähte sonografisch und/oder fluoroskopisch gesteuert werden. Die zu drainierende Kanüle wird dabei via V. femoralis (19)(20)(21)(22)(23) bis auf Höhe des rechten Vorhofs (oder kavoatrialer Übergang) und die zurückführende Kanüle via A. femoralis (15)(16)(17)(18)(19) bis in die A. iliaca communis platziert [5]. Durch die Kanülenanordnung resultieren entsprechend eine umgehende rechtsventrikuläre Entlastung und eine adäquate Perfusion der viszeralen Organe.…”