27th European Cardiology Conference

Biography

Biography: Marco Picichè

Abstract

ECMO (Extracorporeal Membrane Oxygenator) combines a centrifugal pump with a hollow fiber or membrane oxygenator and provides hemodynamic improvement and cardiac and respiratory support with up to 6 l/min nonpulsatile flow. ECMO can be used in a central configuration with the outflow from the distal ascending aorta and inflow from the right atrium, or in a peripheral configuration, involving femoral or subclavian artery and femoral vein. The central approach is generally used following unsuccessful weaning from cardiopulmonary bypass. Peripheral cannulation is generally used for acute cardiac or respiratory failure from nonsurgical causes. Usually, peripheral cannulation is performed percutaneously using the Seldinger technique. Cannulas range from 17 to 21 Fr for arterial cannulation and from 25 to 29 Fr for venous cannulation. Perfusion of the lower limb must be achieved using a 6 Fr cannula inserted into the superficial femoral artery. Otherwise, an 8 mm Dacron graft may be sutured to the femoral or subclavian artery and the outflow cannula inserted inside. This allows the perfusion of the limb. One disadvantage of the peripheral cannulation is the inability to effectively decompress the left ventricle if there is a total absence of left ventricular function. Therefore, a transseptal drainage or venting from the left ventricle or left atrium or pulmonary artery must be instituted. Herein, the different cannulation strategies of ECMO are discussed.