Percutaneous pulmonary artery venting via jugular vein while on peripheral extracorporeal membrane oxygenation running: a less invasive approach to provide full biventricular unloading

Loforte, Antonio; Baiocchi, Massimo; Gliozzi, Gregorio; Coppola, Giuditta; Bartolomeo, Roberto Di; Lorusso, Roberto

doi:10.21037/asvide.2019.039

Cited by 3 publications

(5 citation statements)

References 3 publications

(4 reference statements)

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“…Percutaneous pulmonary artery venting with a 15-Fr drainage cannula via the jugular vein is considered a less invasive technique, which is inserted under fluoroscopy 76)77)…”

Section: Cannulation Management and Complicationsmentioning

confidence: 99%

Clinical Pearls of Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock

2019

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Extracorporeal membrane oxygenation (ECMO) is a technique that uses a pump to drain blood from a body, circulate blood through a membrane lung, and return the oxygenated blood back into the body. Venoarterial (VA) ECMO is a simplified version of the heart-lung machine that assists native pulmonary and/or cardiac function. VA ECMO is composed of a drainage cannula in the venous system and a return cannula in the arterial system. Because VA ECMO can increase tissue perfusion by increasing the arterial blood flow, it is used to treat medically refractory cardiogenic shock or cardiac arrest. VA ECMO has a distinct physiology that is referred to as differential flows. It can cause several complications such as left ventricular distension with pulmonary edema, distal limb ischemia, bleeding, and thromboembolism. Physicians who are using this technology should be knowledgeable on the prevention and management of these complications. We review the basic physiology of VA ECMO, the mechanism of complications, and the simple management of VA ECMO.

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“…Percutaneous pulmonary artery venting with a 15-Fr drainage cannula via the jugular vein is considered a less invasive technique, which is inserted under fluoroscopy 76)77)…”

Section: Cannulation Management and Complicationsmentioning

confidence: 99%

Clinical Pearls of Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock

2019

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“…34 Napp et al (2017), Uribarri et al (2019), Lorusso et al (2020), and Joshi et al (2021) reported percutaneous cannulation of the PA for primary cardiogenic shock with prophylactic use of an oxygenator in 1, 1, 2, and 10 patients, respectively, for an average of 6, 3, 9.1, and 9.5 days of support. 35–38 Direct PA cannulation for drainage using a standard venous ECMO cannula also has been reported as a method of LV unloading while on V-A ECMO, 36,39–41 as has percutaneous PA cannulation for use as an RVAD without an oxygenator. 42,43…”

Section: Discussionmentioning

confidence: 99%

“…34 2021) reported percutaneous cannulation of the PA for primary cardiogenic shock with prophylactic use of an oxygenator in 1, 1, 2, and 10 patients, respectively, for an average of 6, 3, 9.1, and 9.5 days of support. [35][36][37][38] Direct PA cannulation for drainage using a standard venous ECMO cannula also has been reported as a method of LV unloading while on V-A ECMO, 36,[39][40][41] as has percutaneous PA cannulation for use as an RVAD without an oxygenator. 42,43 Concerns regarding PA cannulation include the risk of pulmonary hemorrhage in the setting of high PA flows and valvular damage.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Pulmonary Artery Cannulation to Treat Acute Secondary Right Heart Failure While on Veno-venous Extracorporeal Membrane Oxygenation

et al. 2022

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Right heart failure (RHF) is a common, yet difficult to manage, complication of severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation (ECMO) that is associated with increased mortality. Reports of the use of percutaneous mechanical circulatory support devices for concurrent right heart and respiratory failure are limited. This series describes the percutaneous cannulation of the pulmonary artery for conversion from veno-venous to veno-pulmonary artery return ECMO in 21 patients who developed secondary RHF. All patients cannulated between May 2019 and September 2021 were included. Either a 19 or 21 French venous cannula was placed percutaneously into the pulmonary artery via the internal jugular or subclavian vein, providing a total of 821 days of support (median 23 [4-71] days per patient) with flows up to 6 L/min. Five patients underwent cannulation at the bedside, with the remainder performed in the cardiac catheterization laboratory. Pulmonary artery cannulation occurred after 12 [8.5-23.5] days of ECMO support. Vasoactive infusion requirements decreased significantly within 24 hours of pulmonary artery cannula placement (p = 0.0004). Nonetheless, 75% of these patients expired after a median of 12 [4-63] days of support, with three patients found to have had significant pericardial effusions peri-arrest. This cannulation technique may be an effective alternative to veno-arterial ECMO cannulation or the placement of a dual-lumen cannula for the treatment of RHF.

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“…The same PA cannula could also provide blood flow to the PA in cases with isolated RV failure 7 . The standard guidelines of the Extracorporeal Life Support Organization (https://www.elso.org/Resources/Guidelines.aspx) were applied for weaning patients from V‐A ECMO.…”

Section: Methodsmentioning

confidence: 99%

“…The same PA cannula could also provide blood flow to the PA in cases with isolated RV failure. 7 The standard guidelines of the Extracorporeal Life Support Organization (https://www.elso.org/Resou rces/Guide lines.aspx) were applied for weaning patients from V-A ECMO. The indications for reasonable weaning from PA cannulation included RV free-wall myocardial recovery, a tricuspid annular plane systolic excursion greater than 12 mm, and an arterial and venous saturation greater than 90% and 65%, respectively.…”

Section: Extracorporeal Membrane Oxygenation Configuration and Manage...mentioning

confidence: 99%

Role of percutaneous pulmonary artery cannulation in extracorporeal life support for acute cardiac failure: A single‐center case series

et al. 2022

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Background Pulmonary artery (PA) cannulation is an effective extracorporeal life support (ECLS) management for left ventricular (LV) decompression or right ventricular (RV) support. This case series explores the results of PA cannulation during ECLS for acute cardiac failure. Methods Patients receiving percutaneous PA cannulation between January 2017 and December 2020 in a single institution were retrospectively reviewed. Patients receiving PA cannulation by a surgical cutdown method were excluded. Based on the hemodynamic needs of the patients, percutaneous PA cannulation was applied with ECLS for LV unloading and/or RV support. The primary endpoint was the successful weaning from circulatory support. The secondary endpoints included 30‐day or in‐hospital mortality, significant periprocedural complications, and successful hospital discharge without major complications. Results Fifteen patients (13 men, age range 11.2–70.8 years) presented acute heart failure and were initially managed by conventional ECLS mode. Percutaneous PA cannulation was performed for LV unloading in 13 patients (86.67%) and isolated RV circulatory support in two patients (13.33%). Weaning from circulatory support was achieved in 11 patients (73.33%). No significant periprocedural complication, including bleeding, infection, or vascular event requiring surgical exploration, was reported. The 30‐day or in‐hospital mortality rate was 33.33%. Eight cases (53.33%) were successfully discharged without major complications, including permanent stroke or the need for long‐term hemodialysis. Conclusions PA cannulation, especially percutaneously performed, was effective and safe for LV unloading and/or RV support during ECLS. Further investigation is required to confirm the efficacy and safety of our approach and management in a larger patient population.

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Percutaneous pulmonary artery venting via jugular vein while on peripheral extracorporeal membrane oxygenation running: a less invasive approach to provide full biventricular unloading

Abstract: 5. Lorusso R. Are two crutches better than one? The ongoing dilemma on the effects and need for left ventricular unloading during veno-arterial extracorporeal membrane oxygenation.

Cited by 3 publications

References 3 publications

Clinical Pearls of Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock

Clinical Pearls of Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock

Percutaneous Pulmonary Artery Cannulation to Treat Acute Secondary Right Heart Failure While on Veno-venous Extracorporeal Membrane Oxygenation

Role of percutaneous pulmonary artery cannulation in extracorporeal life support for acute cardiac failure: A single‐center case series

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