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J Thorac Cardiovasc Surg 2009;138:503-506
© 2009 The American Association for Thoracic Surgery

Brief Technique Report

A simple modification of inflow cannula to reduce recirculation of venovenous extracorporeal membrane oxygenation

^a Department of Anesthesia, Far-Eastern Memorial Hospital, Taipei, Taiwan
^b Division of Cardiovascular Surgery, Far-Eastern Memorial Hospital, Taipei, Taiwan
^c Division of Critical Care, Far-Eastern Memorial Hospital, Taipei, Taiwan
^d Department of Mechanical Engineering, Yuan-Ze University, Tao-Yuan County, Taiwan

Received for publication January 28, 2008; accepted for publication February 27, 2008.

^_* Address for reprints: Fang-Ming Horng, MD, Division of Critical Care, Far-Eastern Memorial Hospital, 13F, 21, Sec 2, Nan-Ya S Rd, Ban-Ciao, Taipei County, 220, Taiwan. (Email: philip@mail.femh.org.tw).

The first 20% of the full text of this article appears below.

	Introduction

 
Venovenous extracorporeal membrane oxygenation (VV-ECMO) is commonly used in respiratory distress syndrome. Double cannulation of jugular and femoral veins is the most practical clinical setting for adult patients. Despite the excellent efficiency of membranous oxygenator, recirculation impairs oxygen delivery. There are several clinically practical methods to quantify and monitor recirculation in VV-ECMO applications. However, limited interventions could be done to reduce recirculation. Theoretically, an attempt to insert the inflow cannula into the right ventricle and even the main pulmonary artery may avoid mixing and increase systemic saturation. The procedural complexity and potential risks remain the drawbacks. We introduce a simple modification of manipulating the direction of inflow cannula to address the issue. The preferential flow toward the tricuspid valve and right ventricle significantly increases the efficiency of oxygen delivery. Our findings indicate that the redesign of the conventional cannula results in a significant reduction of recirculation, thereby demonstrating a significant improvement in oxygenation while on VV-ECMO. Patients with extremely poor oxygenation caused by pulmonary disorders are indicated for VV-ECMO.

VV-ECMO is usually considered as the last resort after mechanical ventilation and inhaled nitric oxide for extremely poor oxygenation with various causes. However, based on its intrinsic setting, recirculation between outflow and inflow cannulae remains a clinical obstacle. Recirculation per se significantly impairs systemic oxygenation and contradicts the primary purpose of this practice. Various modifications have been proposed to solve this problem. Locating the outflow cannula in the most desaturated blood and the inflow cannula away from the outflow cannula or toward the downstream chambers (right ventricle or pulmonary artery) is thought to be useful. Most VV-ECMO procedures are performed at bedside. Both inflow . . . [Full Text of this Article]