A.12. What are the common indications for VA-ECMO?
Answer:
VA-ECMO is akin to conventional CPB, in which blood is drained via a cannula placed in the right atrium or inferior vena cava, routed to a pump and an oxygenator/heat exchanger, and returned to the aorta or a large artery (Figures 6.5 and 6.6). As a result, both cardiac and pulmonary support is achieved. The indications for VA-ECMO include post-cardiotomy shock/failure to wean from CPB, reversible cardiogenic shock, as a bridge to a durable ventricular support device, as a bridge to transplantation, and as an adjunct to advanced life support for cardiac arrest (ie, extracorporeal cardiopulmonary resuscitation [ECPR]).
Figure 6.5.: Peripheral Femoral Veinfemoral Artery Veno-Arterial Extracorporeal Membrane Oxygenation (Va-Ecmo) Cannulation.
Peripheral femoral vein—femoral artery veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation. Drainage cannula is placed in the IVC and return cannula is placed in the femoral artery. Peripheral femoral vein—femoral artery V-A ECMO cannulation. Deoxygenated blood (blue) is drained from the femoral vein cannula and oxygenated blood (red) is returned to the femoral artery. AO, aorta; ECMO, extracorporeal membrane oxygenation; IVC, inferior vena cava; LA, left atrium; LV, left ventricle; PA, pulmonary artery; RA, right atrium; RV, right ventricle; SVC, superior vena cava; V-A, veno-arterial.
Figure 6.6.: Cannula Configuration for Central Veno-Arterial Extracorporeal Membrane Oxygenation (Va-Ecmo).
Cannula configuration for central veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Drainage cannula is placed in right atrium and return cannula is placed in ascending aorta. Deoxygenated blood (blue) is drained from the right atrium and oxygenated blood (red) is returned to the femoral artery. AO, aorta; ECMO, extracorporeal membrane oxygenation; IVC, inferior vena cava; LA, left atrium; LV, left ventricle; PA, pulmonary artery; RA, right atrium; RV, right ventricle; SVC, superior vena cava; V-A, veno-arterial.
References
- ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support Extracorporeal Life Support Organization, Version 1.4. Accessed May 14, 2023. www.elso.org
- Mazzeffi MA, Rao VK, Del Rio JM, et al. Intraoperative management of adult patients on extracorporeal membrane oxygenation: an expert consensus statement from the society of cardiovascular anesthesiologists—Part I, technical aspects of extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth. 2021;35:3496-3512.