Table 1 Three different ECMO support options for patients with ARDS and RV failure with listed pros and cons
Configuration | V-P ECMO | V-VP ECMO | VA ECMO |
|---|---|---|---|
Inflow | Right atrium (Protek Duo or two separate cannulas) Right Atrium + Right Ventricle (Spectrum Cannula) | Inferior Vena Cava | Right Atrium |
Outflow | Pulmonary Artery | Right Atrium and Pulmonary Artery Split Flows | Femoral Artery |
Cannulas | Protek Duo (Livanova, UK) 31 French or 29 French Spectrum (Cheltenham, UK) 31 French or 27 French Biomedicus two separate cannulas (Medtronic, MN) 17–21 French outflow and 23–25 French inflow | Protek Duo with 3’8’’ Connector as both limbs are oxygenated. Only possible with Protek Duo Need separate Femoral venous inflow 23–25 french cannula | 23–25 French Internal jugular or femoral venous inflow 15–17 French femoral arterial or axillary artery (sport Mode) outflow |
Advantages | - Complete RV support - Can use dual-lumen single cannula and have only neck cannulation possible with Spectrum or Protek Duo Cannula which increases mobility | Partial RV support Maintain PA pulsatility Avoid excessive flow in the PA | Biventricular support |
Disadvantages | Potential increased risk of pulmonary edema or hemorrhage if there is a drop in LV function, LV diastolic failure, Mitral stenosis, pulmonary embolism | - Increased risk of thrombosis in the lower flow limb Possible - Recirculation between the V-V limb - Requires femoral cannula and can limit mobility | - Leg ischemia and limited by duration of support - Increased risk of stroke and bleeding. - Potentially requires surgical cut down for arterial cannula removal. |