Limits...
Venovenous Extracorporeal Membrane Oxygenation in Intractable Pulmonary Insufficiency: Practical Issues and Future Directions.

Delnoij TS, Driessen R, Sharma AS, Bouman EA, Strauch U, Roekaerts PM - Biomed Res Int (2016)

Bottom Line: Although running a vv-ECMO program is potentially feasible for many hospitals, there are many theoretical concepts and practical issues that merit attention and require expertise.Concepts regarding oxygenation and decarboxylation and how they can be influenced are discussed.Day-to-day management, weaning, and most frequent complications are covered in light of the recent literature.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Maastricht University Medical Center, 6202 AZ Maastricht, Netherlands; Department of Intensive Care, Maastricht University Medical Center, 6202 AZ Maastricht, Netherlands.

ABSTRACT
Venovenous extracorporeal membrane oxygenation (vv-ECMO) is a highly invasive method for organ support that is gaining in popularity due to recent technical advances and its successful application in the recent H1N1 epidemic. Although running a vv-ECMO program is potentially feasible for many hospitals, there are many theoretical concepts and practical issues that merit attention and require expertise. In this review, we focus on indications for vv-ECMO, components of the circuit, and management of patients on vv-ECMO. Concepts regarding oxygenation and decarboxylation and how they can be influenced are discussed. Day-to-day management, weaning, and most frequent complications are covered in light of the recent literature.

No MeSH data available.


Cannulation options in vv-ECMO. (a) Femorojugular configuration. (b) Femorofemoral configuration. (c) Dual-lumen cannula. SVC: superior vena cava. IVC: inferior vena cava. RA: right atrium. TV: tricuspid valve. Adapted from Sidebotham et al. [38].
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4835630&req=5

fig2: Cannulation options in vv-ECMO. (a) Femorojugular configuration. (b) Femorofemoral configuration. (c) Dual-lumen cannula. SVC: superior vena cava. IVC: inferior vena cava. RA: right atrium. TV: tricuspid valve. Adapted from Sidebotham et al. [38].

Mentions: Cannulation in vv-ECMO is dual or single site (Figure 2). Dual site cannulation utilizes the internal jugular and/or femoral vein. The femorojugular approach consists of a long drainage cannula inserted through the femoral vein and advanced into inferior vena cava (IVC) with a shorter return cannula inserted into the internal jugular vein (Figure 2(a)) [24, 25]. The second type of dual cannulation, less often utilized, is the femorofemoral cannulation (Figure 2(b)). Major disadvantages of any dual site approach include increased rate of recirculation, insertion site bleeding, infection, immobilization, clot formation, and accidental dislodgement [26]. A single site bicaval dual-lumen cannula is available for establishing respiratory support by accessing the right internal jugular vein (Figure 2(c)) [27]. The cannula simultaneously drains blood from the superior vena cava (SVC) and IVC, while the oxygenated blood is returned into the right atrium via the infusion port pointing towards the tricuspid valve. Benefits of this cannulation are a reduced risk of insertion site bleeding, thrombosis, infection, and accidental displacement of the cannula while facilitating patient mobilization [26]. Some recirculation, to a limited extent, still occurs as a part of design limitations.


Venovenous Extracorporeal Membrane Oxygenation in Intractable Pulmonary Insufficiency: Practical Issues and Future Directions.

Delnoij TS, Driessen R, Sharma AS, Bouman EA, Strauch U, Roekaerts PM - Biomed Res Int (2016)

Cannulation options in vv-ECMO. (a) Femorojugular configuration. (b) Femorofemoral configuration. (c) Dual-lumen cannula. SVC: superior vena cava. IVC: inferior vena cava. RA: right atrium. TV: tricuspid valve. Adapted from Sidebotham et al. [38].
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835630&req=5

fig2: Cannulation options in vv-ECMO. (a) Femorojugular configuration. (b) Femorofemoral configuration. (c) Dual-lumen cannula. SVC: superior vena cava. IVC: inferior vena cava. RA: right atrium. TV: tricuspid valve. Adapted from Sidebotham et al. [38].
Mentions: Cannulation in vv-ECMO is dual or single site (Figure 2). Dual site cannulation utilizes the internal jugular and/or femoral vein. The femorojugular approach consists of a long drainage cannula inserted through the femoral vein and advanced into inferior vena cava (IVC) with a shorter return cannula inserted into the internal jugular vein (Figure 2(a)) [24, 25]. The second type of dual cannulation, less often utilized, is the femorofemoral cannulation (Figure 2(b)). Major disadvantages of any dual site approach include increased rate of recirculation, insertion site bleeding, infection, immobilization, clot formation, and accidental dislodgement [26]. A single site bicaval dual-lumen cannula is available for establishing respiratory support by accessing the right internal jugular vein (Figure 2(c)) [27]. The cannula simultaneously drains blood from the superior vena cava (SVC) and IVC, while the oxygenated blood is returned into the right atrium via the infusion port pointing towards the tricuspid valve. Benefits of this cannulation are a reduced risk of insertion site bleeding, thrombosis, infection, and accidental displacement of the cannula while facilitating patient mobilization [26]. Some recirculation, to a limited extent, still occurs as a part of design limitations.

Bottom Line: Although running a vv-ECMO program is potentially feasible for many hospitals, there are many theoretical concepts and practical issues that merit attention and require expertise.Concepts regarding oxygenation and decarboxylation and how they can be influenced are discussed.Day-to-day management, weaning, and most frequent complications are covered in light of the recent literature.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Maastricht University Medical Center, 6202 AZ Maastricht, Netherlands; Department of Intensive Care, Maastricht University Medical Center, 6202 AZ Maastricht, Netherlands.

ABSTRACT
Venovenous extracorporeal membrane oxygenation (vv-ECMO) is a highly invasive method for organ support that is gaining in popularity due to recent technical advances and its successful application in the recent H1N1 epidemic. Although running a vv-ECMO program is potentially feasible for many hospitals, there are many theoretical concepts and practical issues that merit attention and require expertise. In this review, we focus on indications for vv-ECMO, components of the circuit, and management of patients on vv-ECMO. Concepts regarding oxygenation and decarboxylation and how they can be influenced are discussed. Day-to-day management, weaning, and most frequent complications are covered in light of the recent literature.

No MeSH data available.