Peripheral VA-ECMO is easier and faster to place emergently, as it can be placed bedside. However, it results in North-South syndrome and increased LV afterload and filling pressures compared to central VA-ECMO. Peripheral cannulation is also associated with an increased risk of limb ischemia and often requires a distal perfusion catheter to perfuse the leg with the arterial cannula.

Central VA-ECMO cannulation (most often placed when unable to wean from CPB) is associated with less risk of right upper extremity and right cerebral ischemia, and less risk of limb ischemia. In addition, it can unload the heart better than peripheral cannulation because of improved LV emptying and decreased afterload. However, it involves surgical removal and is associated with an increased risk of infection, increased reoperation risk for bleeding or tamponade, and higher transfusion requirements.

References

• ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support Extracorporeal Life Support Organization, Version 1.4. Accessed May 14, 2023. www.elso.org
• Mariscalco G, Salsano A, Fiore A, et al. Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: multicenter registry, systematic review, and meta-analysis. J Thorac Cardiovasc Surg. 2020;160:1207-1216.e44.
• Rao P, Khalpey Z, Smith R, Burkhoff D, Kociol RD. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circ Heart Fail. 2018;11:e004905.