ECLS Cannulation Technical Updates

The discussions about ECLS cannulation may involve many different issues. Who may cannulate in your institution? This publication offers data to say that it may be done safely and efficaciously with imaging support by intensivists in an ICU environment. Percutaneous Cannulation for Extracorporeal Membrane Oxygenation by Intensivists: A Retrospective Single-Institution Case Series
Conrad, Steven A. MD, PhD, MCCM; Grier, Laurie R. MD, FCCM; Scott, L. Keith MD, FCCM; Green, Rebecca MD; Jordan, Mary RN, MSN. The authors describe their experience with “One hundred ninety cannulations with cannula sizes from size 12 to 31F were performed by four intensivists in 100 subjects. Twenty-three were arterial (12-16F) and 167 were venous (12-31F). “They list the use of imaging guidance for their patients including pre-insertion ultrasound, fluoroscopy, and the use of ultrasound guidance during insertion of the cannulas. The authors conclude that “Percutaneous cannulation for extracorporeal membrane oxygenation by intensivists can be performed with a high rate of success and a low rate of complications when accompanied by imaging support. “How do you cannulate? The typical thought process is that “bigger is better”. Perhaps with arterial access, that may not hold true. This paper describe their experience with two groups of patients: one with varying larger sizes of arterial cannulas and the second using the 15fr arterial cannula. They report clinical success and a decrease in bleeding occurrence in the group using the smaller size return cannula. Feasibility of Smaller Arterial Cannulas in Veno-arterial Extracorporeal Membrane Oxygenation
Hiroo Takayama, MD, PhD; Elissa Landes, MD; Lauren Truby, BS; Kevin Fujita, BS; Ajay J. Kirtane, MD, SM; Linda Mongero, CCP; Melana Yuzefpolskaya, MD; Paolo C. Colombo, MD; Ulrich P. Jorde, MD; Paul A. Kurlanski, MD; Koji Takeda, MD, PhD; Yoshifumi Naka, MD, PhD  Article Review by: M. Heard

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