Cannulation for veno-venous extracorporeal membrane oxygenation

Extracorporeal membrane oxygenation (ECMO) is described as a modified, smaller cardiopulmonary bypass circuit that is used for a short period (days to weeks) in patients with acute cardiac and/or respiratory failure refractory to conventional management (1). The Extracorporeal Life Support Organization (ELSO) present different modes of ECMO, veno-venous (VV) and veno-arterial (VA) being the two basic principles (2). The VV ECMO circuit drains venous blood, oxygenate the blood, and pump the blood back into the same venous compartment. That means that the VV ECMO circuit is totally separated from the patients’ cardiac output (CO). With no CO the pump flow in the ECMO circuit will result in 100% recirculation. Cardiac function and CO is needed to deliver oxygen to the tissues. The VA ECMO circuit drain venous blood, oxygenate and pump the blood back into the arterial vascular compartment, therefore not dependent on cardiac function and CO. VA ECMO can thus replace CO completely and deliver oxygen to tissues without cardiac function. VV ECMO is an established method and when used in experienced ECMO centers it improves survival in patients suffering from severe ARDS or respiratory insufficiency (3-7)