Risk of harlequin syndrome during bi-femoral peripheral VA-ECMO: should we pay more attention to the watershed or try to change the venous cannulation site?

Access site complications of postcardiotomy extracorporeal life support

“…Although femoral arterial cannulation is a commonly used access site at many centers, indirect axillary artery cannulation has evolved to be a preferred arterial access site for PC-ECLS at our center for the benefit of predominantly antegrade body perfusion, avoidance of lower limb ischemia, as well as reduction of differential hypoxemia (ie, Harlequin effect) in patients with impaired pulmonary function. 15,16,23 A reported high rate of hyperperfusion syndrome in axillary cannulation 24 can be addressed easily by application of a silicone vessel loop distal to the cannulation site and biradial invasive blood pressure monitoring to enable regulation of distal blood flow. In the setting of CPB weaning failure where a direct switch from CPB to ECLS is conducted, there is usually enough time to allow the more time-consuming indirect axillary artery cannulation.…”

“…Cannulation of the axillary artery allows for predominantly antegrade body perfusion and proximal shift of the watershed, therefore preventing differential hypoxemia in patients with compromised pulmonary function. [15][16][17][18] Another obvious advantage of axillary cannulation is the uncompromised leg perfusion, avoiding leg ischemia and related problems. For the stated reasons, indirect axillary artery cannulation via side graft has evolved to be the preferred access site for elective implantation at our center in recent years, whereas the femoral artery remains the access of choice in cases where rapid ECLS initiation is required.…”

Application of extracorporeal membrane oxygenation to treatment of serious tracheal stenosis caused by relapsing polychondritis: a case report and literature review

“…Currently, there is no reference regarding whether ECMO should be used as a preventive measure in airway treatments for patients with airway stenosis. Numerous articles have reported that early prophylactic ECMO catheterization can successfully prevent sequelae 9 , 10 ; however, there is a scarcity of high-quality studies at the present time.…”

Optimizing Outcomes in Extracorporeal Membrane Oxygenation Postcardiotomy in Pediatric Population

“…33 Strategies to oppose combat the development of Harlequin syndrome include altering the cannulation site. 34,35…”