title: Extracorporeal membrane oxygenation by single-vessel access in adults:  advantages and limitations.
abstract: Veno-venous extracorporeal membrane oxygenation (vvECMO) conventionally requires the cannulation of two vessels. Here we report our initial experience with the "Wang-Zwische" (WZ) double-lumen cannula. In a group of n = 36 patients single venous cannulation for vvECMO was performed. A retrospective analysis was executed. A comparison of flow characteristics to standard two-vessel cannulation was performed. Mean age of the patient population was 48 ± 15 years (body mass index [BMI] 32 ± 13 kg/m(2)). In n = 32 patients (89%) the cannula was implanted percutaneously under echo or fluoroscopic guidance in less than 30 minutes. Nine patients were partially mobilized on extracorporeal membrane oxygenation (ECMO) support. Oxygenation (partial arterial oxygen tension [PaO(2)]/fraction of inspired oxygen [FiO(2)]) improved significantly in all patients from 66 mm Hg (interquartile range [IQR] 58-87 mm Hg) before ECMO to 117 mm Hg (IQR 95-195 mm Hg, p = 0.001) after 24 hours. In seven patients (19%) nonfatal adverse events occurred, including three dislocations, two partial cannula thrombosis, one ventricular perforation, and one retroperitoneal hemorrhage. The negative pressures for drainage at a flow of 2.5 L/min were significantly lower in a standard (S) two-vessel approach compared with a WZ approach (S: -9 mm Hg; IQR -3 to -24 mm Hg, vs. WZ: -23 mm Hg; IQR -4 to -40 mm Hg; p = 0.04). The WZ cannula offers sufficient gas exchange in addition to certain advantages over standard cannulation, including facilitated cannulation in selected patients and improved mobilization.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Regensburg, Germany. daniele.camboni@klinik.uni-regensburg.de
authors.forename: Daniele
authors.initials: D
authors.lastname: Camboni
authors.forename: Alois
authors.initials: A
authors.lastname: Philipp
authors.forename: Matthias
authors.initials: M
authors.lastname: Lubnow
authors.forename: Thomas
authors.initials: T
authors.lastname: Bein
authors.forename: York
authors.initials: Y
authors.lastname: Zausig
authors.forename: Michael
authors.initials: M
authors.lastname: Hilker
authors.forename: Bernhard
authors.initials: B
authors.lastname: Flörchinger
authors.forename: Leopold
authors.initials: L
authors.lastname: Rupprecht
authors.forename: Andreas
authors.initials: A
authors.lastname: Keyser
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kobuch
authors.forename: Dirk
authors.initials: D
authors.lastname: Lunz
authors.forename: Simon
authors.initials: S
authors.lastname: Schopka
authors.forename: Assad
authors.initials: A
authors.lastname: Haneya
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011659:Pulmonary Gas Exchange