Veno-right ventricular cannulation reduces recirculation in extracorporeal membrane oxygenation

Abstract

Background: Veno-venous extracorporeal membrane oxygenation has several advantages over veno-arterial support for patients with severe reversible respiratory failure. However, recirculation can limit oxygen delivery as pump flow increases. This could be ameliorated by placing the return catheter in the right ventricle instead of the central veins. We compared recirculation in veno-right ventricular support with that in conventional veno-venous support and its relationship with pump flow. Methods: Five greyhound dogs were sequentially cannulated percutaneously for both veno-venous and veno-right ventricular support. Recirculation was measured by comparing oxygen levels in the circuit drainage and return lines before and immediately after a sudden increase in circuit oxygenation at pump flows between 0.5 L/min and 4 L/min for both modalities. Results: Recirculation was reduced in veno-right ventricular support compared with conventional veno-venous support at 4 L/min pump flow (8.4% versus 37.9%, p=0.0076) and increased less with increases in pump flow (2.9% per 1 L/min vs. 11.1% per 1 L/min, p<0.0001). Conclusions: Recirculation can be dramatically reduced by returning blood into the right ventricle, which improves oxygen delivery to the lungs and the systemic circulation. The design of specialized catheters may facilitate percutaneous ventricular cannulation, improve safety and further reduce recirculation.

Recirculation in Venovenous Extracorporeal Membrane Oxygenation

“…29 This strategy, referred to as veno-right ventricular ECMO, resulted in significantly less recirculation at 4 L/min of blood flow (8.4% vs. 37.9%, p = 0.008) and less of an increase in recirculation for every 1 L change in blood flow (2.9% vs. 11.1%, p < 0.0001). However, placement of the reinfusion cannula into the right ventricle was associated with endocardial damage and arrhythmias, which limits its clinical application.…”

Cannulation strategies for percutaneous extracorporeal membrane oxygenation in adults

“…Malposition may facilitate recirculation, i.e., drainage of freshly oxygenated blood back into the extracorporeal circuit, which may become a substantial problem during therapy. Hence it is essential to verify optimal cannula position by fluoroscopy, chest X-ray or transesophageal echocardiography [ 16 ], and modifying the tip of the supplying cannula [ 17 ] or positioning it in the right ventricle [ 18 ] have been proposed to reduce recirculation.…”

Optimal flow adjustment of veno‐venoarterial extracorporeal membrane oxygenation with an adaptive prediction model: cannula sizes screening and pump speeds estimation

“…In ECMO circuits' indications, VA cannulation model can support patient's both heart and lung function to gain time to treat patient's underline disease; but, if patient's disease only limited on lung: veno-venous (VV) ECMO model has a lower risk and some advantages, such as gas exchange improvement and lungs rest, over the VA model support for patients with ARDS and ARF. However, VV ECMO still sometimes cannot meet patient's demand; we might still see the oxygenation is very poor which might cause the patient's condition worsen [12][13][14]. Sometimes, using VA ECMO mode through the femoral vein and femoral artery might cause poorer oxygenated blood in the upper body than in the lower body due to still with some cardiac output from heart [4].…”