title: Early Experience with a Novel Cannulation Strategy for Left Ventricular Decompression during Nonpostcardiotomy Venoarterial ECMO.
abstract: Advances in technology for the delivery of venoarterial extracorporeal membrane oxygenation (VA-ECMO) have allowed for its expanded utilization in the treatment of patients with advanced cardiogenic shock, particularly through the use of peripheral cannulation strategies. However, peripheral VA-ECMO continues to be hampered by several major limitations including inadequate decompression of the left ventricle, lower limb ischemia, and the inability to mobilize patients. Here, we present a case series of three patients who were treated with a hybrid peripheral-central cannulation strategy accompanied by direct decompression of the left ventricle through a right anterior mini-thoracotomy. This novel approach ameliorates several of the current limitations to peripheral VA-ECMO therapy and thereby holds potential for improving outcomes in VA-ECMO patients.
authors.affiliation: From the *Department of Surgery, Division of Cardiothoracic Surgery, †Division of Perfusion Services, and ‡Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Keenan
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Schechter
authors.forename: Desiree K
authors.initials: DK
authors.lastname: Bonadonna
authors.forename: Raquel R
authors.initials: RR
authors.lastname: Bartz
authors.forename: Carmelo A
authors.initials: CA
authors.lastname: Milano
authors.forename: Jacob N
authors.initials: JN
authors.lastname: Schroder
authors.forename: Mani A
authors.initials: MA
authors.lastname: Daneshmand
mesh_terms: D002404:Catheterization; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012770:Shock, Cardiogenic / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods*