Cannulation technique: femoro-femoral

Optimal cannulation technique is essential for the initiation and management of patients with severe respiratory failure requiring veno-venous extracorporeal membrane oxygenation (VV ECMO). Cannulation must be rapid and with a technique that minimizes tissue trauma, which can lead to bleeding and transfusion requirements, reoperation, infection risk and longer-term morbidity. Inappropriately positioned cannulas can result in poor circuit flows, recirculation and inadequate support. Moving malpositioned cannulas can expose the patient to non-sterile parts of the cannula and increase the risk of infection. Poorly secured cannulas can lead to catastrophic decannulation. In the following discussion, we will describe in detail the VV ECMO cannulation techniques that have been developed in our hospital in over 25 years of practice and discuss the various advantages and disadvantages of each technique