In vvecmo, the drainage cannula is usually inserted into the right femoral vein. Extracorporeal membrane oxygenation for adult respiratory. What is the objective of mechanical ventilation in an ards patient on vv ecmo. More recently a singlesite venovenous ecmo cannula has become available for sizes suitable for adults and children which allows mobilization of the patient due to lack of a femoral cannula. Venovenous ecmo vvecmo can provide quite complete respiratory support, even if this highly complex technique presents substantial risks, such as bleeding, thromboembolic events and infection. Elso guidelines for training and continuing education of ecmo specialists version 1. The 26 yearold man from everything ecmo 001 received vv ecmo for severe ards secondary to influenza.
Some centers have adopted a philosophy that if conventional interventions fail, the degree of lung hypoplasia and subsequent pulmonary hypertension is considered nonlife sustaining and ecmo is felt to be useless ecmo continues to be used as somewhat of a rescue modality, but survival rates have remained at 50%. Drake from westland medical center, weslland, michigan, and the university of michigan medical center, ann arbor, michigan, u. We also consider an oxygen requirement of 70% for 710 days prior to ecmo consultation to be a positive risk factor for poor outcome with vv ecmo and a contraindication for cannulation table 1. This study describes the use of cephalad cannulae and identifies rudimentary data. Oct 31, 2016 extracorporeal membrane oxygenation ecmo is used as a lifesaving rescue treatment in refractory respiratory or cardiac failure. Extracorporeal membrane oxygenation radiology reference. Cannulation strategies in adult venoarterial and veno. Certain patients receiving extracorporeal membrane oxygenation ecmo or continuous renal replacement therapy crrt may also benefit from positional therapy.
Ecmo therapy works by draining blood through a drainage cannula with blood pump and then removing the carbon dioxide and adding oxygen to the blood using a membrane lung. Extracorporeal respiratory support in adult patients ncbi. Venovenous doublelumen single cannula extracorporeal membrane. Elso registry form cannula list ecmo and ecls home. Venous cannula position can impede forward flow, as can right or left atrial volume, and poor contractility. The ecmo machine will drain the blood from the vein through the cannula, oxygen will be added to the. The extracorporeal membrane oxygenation ecmo venous cannula. Venoarterial ecmo top previous next note that the va and vv ecmo systems are both accessed through ecmo system menu item and that the ecmo system is switched between these modes using the control at the bottom righthand side of the ecmo system interface. You will gain handson experience of optimising us technique, bifemoral cannulation, femorojugular cannulation including the avalon, distal perfusion cannulas and echo views essential for cannula positioning. Use the avalon introducer kit to dilate the vessel to about 1 size below the cannula. Cannula design and recirculation during venovenous extracorporeal membrane oxygenation.
Venovenous vv extracorporeal membrane oxygenation ecmo the aim of this leaflet is to help answer some of the questions you may have about your relative requiring ecmo. Venovenous vv ecmo is desirable to avoid common carotid artery ligation. In case of cracks or ruptures of the circuit that occur after the pump, the pump. Complications of neonatal extracorporeal membrane oxygenation. Disadvantages include upper body hypoxemia, aortic root thrombus formation, left ventricular distension, and lower. Chimot l, marque s, gros a et al 20 avalon bicaval duallumen cannula for venovenous extracorporeal membrane oxygenation. Double lumen cannula for vv ecmo radiology reference. Adults were randomized either to vv ecmo at glenfield hospital, leicester, england 90 patients or continuing conventional care at referral hospitals 90 patients 68 received ecmo. Cannula design and recirculation during venovenous. Right ventricular rupture and tamponade caused by malposition. Echocardiography provides real time feedback during cannula placement and plays a fundamental role in the correct position of the ecmo cannula.
Post ecmo initiation assessment of access insufficiency evaluation of the problem of access insufficiency chattering of access line should include echo. The importance of training, planning and preparing for the worst ecmo emergencies. Use of a dual lumen cannula for venovenous extra corporeal. Right ventricular rupture and tamponade caused by malposition of the avalon cannula for venovenous extracorporeal membrane oxygenation hitoshi hirose1, kentaro yamane1, gregary marhefka2 and nicholas cavarocchi1 abstract placement of the avalon elite bicaval dual lumen cannula for venovenous extracorporeal membrane oxygenation. Vv ecmo is used for respiratory failure refractory to mechanical ventilation, in the. Aug 29, 2002 prone positioning in respiratory failure has been shown to be a useful adjunct in the treatment of severe hypoxia. Extracorporeal life support organization elso ultrasound. My surgeon converted to a venoaterialvenous ecmo from venovenous ecmo and placed a distal perfusion limb catheter. If the return cannula or part of it is damaged, recannulation is required see everything ecmo 010. Venovenous vv extracorporeal membrane oxygenation ecmo is a temporary mechanical assistance device that allows for prolonged cardiopulmonary support. The technique will be the same as listed on this page for 2 catheters 1 of them will not be inserted.
Increased risk of cardiovascular perforation during ecmo with a. Cannula malposition often requires a second operation, putting the patient at additional risk for infection, bleeding, or death. Deirdre murphy is deputy director, intensive care and head of the cardiothoracic icu at the alfred hospital. If forward flow is impeded, pao 2, cardiac output and oxygen delivery fall. Ivc drainage both in venovenous two cannula ecmo and in venoarterial ecmo with blood return to the. Pranya sakiyalak, md facs faculty of medicine siriraj hospital. In venovenous bypass, a doublelumen cannula is placed through the right jugular vein into the right atrium.
May 01, 2014 this video shows how to place a patient on venovenous ecmo. Venovenous extracorporeal membrane oxygenation for lung. Experience with the avalon bicaval doublelumen veno. Vv or va persists, it is reasonable to proceed with va cannulation and consider conversion to vv if necessary at a later time. Note that the va and vv ecmo systems are both accessed through ecmo system menu item and that the ecmo system is switched between these modes using the control at the bottom righthand side of the ecmo system interface. While vvecmo circuits usually include the cannulation of two vessels double cannulation in the classic configuration, the use of a single cannula is now possible for vvecmo support. The term triple cannulation primarily means the use of three cannulae. Vv ecmo has the return cannula placed in the venous system for lung support. Venovenous extracorporeal membrane oxygenation therapy in. The cannulation is usually performed via the right jugular. Annual patient survival rate and annual total patients treated with ecmo. Venovenous extracorporeal membrane oxygenation ecmo using a.
Introduction of a double lumen vv ecmo cannula avalon. Triple cannulation ecmo is a novel and complex form of mechanical support. Extracorporeal membrane oxygenation ecmo, also known as extracorporeal life support ecls, is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange or perfusion to sustain life. Comparing percutaneous to open access for extracorporeal. Venovenous extracorporeal membrane oxygenation ecmo using a doublelumen cannula alice french andrews, joseph b.
Peripheral va ecmo cannulation is often done bedside and can even be accomplished in patients undergoing chest compressions. Ecmo safety is the avoidance of unnecessary incidents that result in adverse patient outcomes. One or two cannulas are placed in large vein s on the side of the neck or in the groin area at the top of the leg. It explains the benefits, risks and alternatives to the therapy. Venovenous extracorporeal membrane oxygenation in intractable. Ecmo therapy equipment consists of a blood pump, a membrane lung also called an oxygenator, conduit tubing, a heat exchanger, and two cannulas for drainage and blood return. The venovenous ecmo module is intended for use by those undergoing training in this technique and is intended for. However, the prone position can result in dislodgment or malfunction of tubes and cannulae. Serial dilatations of the venous puncture site are then performed and. For femoral insertion, use toe trans oesophageal echo to confirm that the wire is in the ivc, position the cannula tip in the ivc below the level of the diaphragm.
Considerations objectives in adult ecmo venovenous veno. Subset analysis of patients on venovenous vv ecmo revealed higher rates of. Venovenous twosite cannulation versus venovenous double. Subsequently, two prospective randomized studies helped establish ecmo as the.
Fortunately he has improved since you corrected his persistent hypoxaemia. A modification of the cardiopulmonary bypass machine, it is instituted in patients with lifethreatening respiratory failure predicted mortality 80 percent. Echocardiography is the study of choice to clarify cannula position. T1 experience with the avalon bicaval doublelumen venovenous cannula for neonatal respiratory ecmo. After your final dilation, load your introducer onto the 150 cm wire. Advance the introducer through the soft tissue, far enough that you actually dilate the wall of the femoral vein. Venovenous vv extracorporeal membrane oxygenation ecmo.
During venovenous vv ecmo, the presence of recirculation is known, but quantification and actions to minimize recirculation after measurement are to date not routinely practiced. Ecmo offers several advantages such as cannulation with. Prone positioning does not affect cannula function during. The manufacturers of the avalon cannula recommend either fluoroscopy or. There were 40 other events reported for other brands of ecmo cannulas, most of which were relatively mundane such as cracking or kinking of cannulas or leakage around one brand of femoral cannula. Venovenous extracorporeal membrane oxygenation v v ecmo. However, va ecmo is generally more straightforward in terms of cannulation and if significant doubt re. Classically vv ecmo support is provided using two separate cannulation sites. Restart ecmo once the breach is repaired or overcome and all clamps are removed again, the main difference between vv and va ecmo in this circumstance is that in vv ecmo additional ventilatory support is the priority during the emergency. The author uses an avalon catheter inserted into the right jugular vein.
In most cases, it is instituted by adding a third cannula to an existing vv or vaecmo circuit. Repeat this step for each dilator up until you reach the appropriate size for your chosen cannula. Vv ecmo can be done via several methods jugulofemoral as seen on this page for the femoral catheter and the ij catheter insertion is coming soon femoralfemoral not ideal but sometimes necessary. Ecmo flow rate is highly dependent on drainage cannula flow rate which is. When used during extracorporeal membrane oxygenation ecmo, jugular venous bulb catheters, known as cephalad cannulae, increase venous drainage, augment circuit flow and decompress cerebral venous pressure. The main objective is to prevent ventilatorinduced lung injury vili and to allow the. The use of double lumen cannula for venovenous ecmo in trauma patients with ards martin gothner1, dirk buchwald2, justus t strauch2, thomas a schildhauer1 and justyna swol1 abstract background.
Elso office 2800 plymouth rd building 300, room 303 ann arbor, mi 481092800 phone. Conventional extracorporeal membrane oxygenation ecmo training usually only consists of didactic. Avoid the use of alcohol on the polycarbonate material to prevent cracks. Choice of cannula size is critical to enable good support of the patient. The use of cephalad cannulae to monitor jugular venous oxygen. Considerations objectives in adult ecmo venovenous venoarterial. Optimized cerebral oxygen delivery during ecmo may contribute to a reduction in neurological morbidity. Desaturated blood is withdrawn from the right atrium through the outer fenestrated.
The use of double lumen cannula for venovenous ecmo in. Ecmo pranya sakiyalak, md facs faculty of medicine siriraj hospital. Venovenous extracorporeal membrane oxygenation vv ecmo is a form of extracorporeal life support that provides total gas exchange co2 and o2 within the central venous circulation. There were also two reports of cracked cannulas and one of a torn vein with cannula removal. Anatomy of an percutaneous ecmo cannulation femoral vein cannulation continuing our ecmo education series, below is a video from one of our recent ecmo cannulations along with an outline of the steps, pearls, and pitfalls when initiating ecmo. However, the best technique of venous access for vv ecmo is not established.
Pdf cannula design and recirculation during venovenous. A duallumen bicaval cannula for venovenous extracorporeal. The double lumen cannula enables venovenous extracorporeal membrane oxygenation vv ecmo to patients with severe respiratory failure. Used for primary respiratory failure when va cannulation is the only option approach. We do not expect any prior ecmo experience, enthusiastic beginners are most welcome. Simulation training on extracorporeal membrane oxygenation. A weaning protocol for venovenous extracorporeal membrane. Using a single cannula with a doublelumen 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. A case of avalon cannula malposition and successful. Anatomy of an percutaneous ecmo cannulation femoral vein. The avalon catheter has an inflow lumen that takes blood from the ivc and svc, and an outflow lumen that delivers blood towards the tricuspid valve. The use of a double lumen cannula for venovenous extracorporeal membrane oxygenation v. Using the vvecmo configuration, the drainage cannula 1925 fr5570 cm of. If you have any questions or concerns, please do not hesitate to speak to the doctors or.
1390 1458 1340 836 1455 554 6 1251 732 365 474 1297 674 535 225 707 1133 942 617 760 1441 118 1400 95 973 763 446 1288 129 792 287 458 673