Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation

Takayama, Hiroo; Landes, Elissa; Truby, Lauren K.; Fujita, Kevin; Kirtane, Ajay J.; Mongero, Linda B.; Yuzefpolskaya, M.; Colombo, P.C.; Jorde, Ulrich P.; Kurlansky, Paul; Takeda, Koji; Naka, Yoshifumi

doi:10.1016/j.jtcvs.2015.01.042

Cited by 77 publications

(70 citation statements)

References 24 publications

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“…Properly sized arterial and venous cannulae will provide sufficient circulatory support with less complications. But, it is easy to overlook hemodynamic characteristics of these cannulae themselves as such information is not readily available in the literature . Therefore, translational research is needed to fill the gap between bench and bedside.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Two Femoral Arterial Cannulae With Conventional Non‐Pulsatile and Alternative Pulsatile Flow in a Simulated Adult ECLS Circuit

et al. 2018

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The objective of this study is to evaluate the hemodynamic characteristics of two femoral arterial cannulae in terms of circuit pressure, pressure drop, and hemodynamic energy transmission under non-pulsatile and pulsatile modes in a simulated adult extracorporeal life support (ECLS) system. The ECLS circuit consisted of i-cor diagonal pump and console (Xenios AG, Heilbronn, Germany), an iLA membrane ventilator (Xenios AG), an 18 Fr or 16 Fr femoral arterial cannula (Xenios AG), and a 23/25 Fr Estech remote access perfusion (RAP) femoral venous cannula (San Ramon, CA, USA). The circuit was primed with lactated Ringer's solution and packed red blood cells to achieve a hematocrit of 35%. All trials were conducted at room temperature with flow rates of 1-4 L/min (1 L/min increments). The pulsatile flow settings were set at pulsatile frequency of 75 bpm and pulsatile amplitudes of 1000-4000 rpm (1000 rpm increments). Flow and pressure data were collected using a custom data acquisition system. Total hemodynamic energy (THE) is calculated by multiplying the ratio between the area under the hemodynamic power curve (∫flow × pressure dt) and the area under the pump flow curve (∫flow dt) by 1332. The pressure drop across the arterial cannula increased with increasing flow rate and decreasing cannula size. The pressure drops of 18 Fr and 16 Fr cannulae were 19.4-24.5 and 38.4-45.3 mm Hg at 1 L/min, 55.2-56.8 and 110.9-118.3 mm Hg at 2 L/min, 94.1-105.1 and 209.7-215.1 mm Hg at 3 L/min, and 169.2-172.6 and 376.4 mm Hg at 4 L/min, respectively. Pulsatile flow created more hemodynamic energy than non-pulsatile flow, especially at lower flow rates. The percentages of THE loss across 18 Fr and 16 Fr cannula were 16.0-18.7 and 27.5-30.8% at 1 L/min, 35.1-35.7 and 52.3-53.8% at 2 L/min, 48.3-50.3 and 67.3-68.4% at 3 L/min and 62.9-63.1 and 79.0% at 4 L/min. The hemodynamic performance of the arterial cannula should be evaluated before use in clinical practice. The pressure drops and percentages of THE loss across two cannulae tested using human blood were higher compared to the manufacturer's data tested using water. The cannula size should be chosen to match the expected flow rate. In addition, this novel i-cor ECLS system can provide non-pulsatile and ECG-synchronized pulsatile flow without significantly increasing the cannula pressure drop and hemodynamic energy loss.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Two Femoral Arterial Cannulae With Conventional Non‐Pulsatile and Alternative Pulsatile Flow in a Simulated Adult ECLS Circuit

et al. 2018

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“…However, these data are difficult to interpret given small sample size and increased Impella ® 2.5 use in the small cannula group. [ 25 ]…”

Section: Cannula Sizingmentioning

confidence: 99%

Cannulation strategies in adult veno-arterial and veno-venous extracorporeal membrane oxygenation: Techniques, limitations, and special considerations

et al. 2017

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Extracorporeal membrane oxygenation (ECMO) refers to specific mechanical devices used to temporarily support the failing heart and/or lung. Technological advances as well as growing collective knowledge and experience have resulted in increased ECMO use and improved outcomes. Veno-arterial (VA) ECMO is used in selected patients with various etiologies of cardiogenic shock and entails either central or peripheral cannulation. Central cannulation is frequently used in postcardiotomy cardiogenic shock and is associated with improved venous drainage and reduced concern for upper body hypoxemia as compared to peripheral cannulation. These concerns inherent to peripheral VA ECMO may be addressed through so-called triple cannulation approaches. Veno-venous (VV) ECMO is increasingly employed in selected patients with respiratory failure refractory to more conventional measures. Newer dual lumen VV ECMO cannulas may facilitate extubation and mobilization. In summary, the pathology being addressed impacts the ECMO approach that is deployed, and each ECMO implementation has distinct virtues and drawbacks. Understanding these considerations is crucial to safe and effective ECMO use.

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“…15 and 17 French size) worldwide. Several authors and clinical trials have reported successful patient outcomes and uncomplicated ECMO runs with such reduced cannula calibers. The reduced size is certainly an advantage, particularly in percutaneously performed cannulation, facilitating cannula placement and withdrawal.…”

Section: Cannulation Techniquesmentioning

confidence: 99%

Choosing the appropriate configuration and cannulation strategies for extracorporeal membrane oxygenation: the potential dynamic process of organ support and importance of hybrid modes

Sorokin

MacLaren

Vidanapathirana

et al. 2017

European J of Heart Fail

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Extracorporeal membrane oxygenation (ECMO) is becoming a common procedure to support patients with severe cardio-circulatory or respiratory failure as well as in case of combined compromise of the two systems. Deciding which ECMO configuration and proceeding with an uneventful implantation, however, may present minor or major shortcomings. Cannulation techniques should be tailored to specific patient conditions to provide sufficient regional and systemic perfusion, both of which must be comprehensively monitored. Changes in the patient's status or suboptimal ECMO-related support, however, may occur and should trigger re-appraisal of the cannulation strategy and circuit configuration. This dynamic management, based around the adequacy of end organ perfusion and patient requirements, may dictate ECMO configuration and cannulation changes. In these circumstances, adjunct of a cannula in the venous or arterial vasculature may represent a mandatory procedure to solve unfavorable hemodynamic status or enhance ECMO efficiency. These type of ECMO configurations, different from basic one, and called hybrid configurations, may represent, therefore, a critical aspect of optimal ECMO management towards optimized and successful temporary support. The aim of this review is to critically appraise and summarize the existing literature on adult ECMO configuration including cannulation strategies and circuit arrangement, and highlighting more complex pattern required in some specific clinical settings.

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Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation

Abstract: Compared with the use of larger cannulas, ECMO with a 15F arterial cannula appears to provide comparable clinical support with reduced bleeding complications.

Cited by 77 publications

References 24 publications

Evaluation of Two Femoral Arterial Cannulae With Conventional Non‐Pulsatile and Alternative Pulsatile Flow in a Simulated Adult ECLS Circuit

Evaluation of Two Femoral Arterial Cannulae With Conventional Non‐Pulsatile and Alternative Pulsatile Flow in a Simulated Adult ECLS Circuit

Cannulation strategies in adult veno-arterial and veno-venous extracorporeal membrane oxygenation: Techniques, limitations, and special considerations

Choosing the appropriate configuration and cannulation strategies for extracorporeal membrane oxygenation: the potential dynamic process of organ support and importance of hybrid modes

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