title: First experiences with a combined usage of veno-arterial and veno-venous ECMO in therapy-refractory cardiogenic shock patients with cerebral hypoxemia.
abstract: The use of extracorporeal membrane oxygenation (ECMO) is becoming a popular tool in the treatment of cardiogenic shock. We present two case reports where classical veno-arterial peripherally cannulated ECMO therapy proved insufficient with profuse cerebral hypoxemia. After augmenting the setting into veno-veno-arterial ECMO, we achieved a remarkable improvement of all oxygenation parameters. The simultaneous use of veno-venous and veno-arterial ECMO might display as a novel strategy to counteract the coronary and cerebral hypoxemia in veno-arterial ECMO therapy in patients with therapy-refractory cardiogenic shock or in combined cardiopulmonary failure. In this manuscript, the veno-veno-arterial ECMO setup is described in full detail and different venous cannulas are discussed.
authors.affiliation: Department of Anesthesiology and Critical care medicine, Halle-Wittenberg University, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Moravec
authors.forename: T
authors.initials: T
authors.lastname: Neitzel
authors.forename: M
authors.initials: M
authors.lastname: Stiller
authors.forename: B
authors.initials: B
authors.lastname: Hofmann
authors.forename: D
authors.initials: D
authors.lastname: Metz
authors.forename: M
authors.initials: M
authors.lastname: Bucher
authors.forename: R
authors.initials: R
authors.lastname: Silber
authors.forename: H
authors.initials: H
authors.lastname: Bushnaq
authors.forename: C
authors.initials: C
authors.lastname: Raspé
mesh_terms: D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012770:Shock, Cardiogenic / Q000150:complications / Q000503:physiopathology / Q000601:surgery*
keywords: ECMO bypass; ECMO cerebral hypoxemia; cardiogenic shock; cardiopulmonary failure; combined ECMO; veno-arterial ECMO; veno-veno-arterial ECMO; veno-venous ECMO