title: Pitfalls in percutaneous ECMO cannulation.
abstract: BACKGROUND
  This observational report depicts typical problems of extracorporeal membrane oxygenation cannulation from a large case series of a single center.
  
  
  METHODS
  We analysed our experience with 720 consecutive patients receiving veno-venous or veno-arterial extracorporeal membrane oxygenation focusing on the spectrum of complications occurring in a subset of 159 patients treated with percutaneous veno-arteria extracorporeal membrane oxygenation in our institution between January 2009 to December 2014.
  
  
  RESULTS
  The main problems were: vascular complications or ischemia of the corresponding extremity (leading to surgical revision in 16.9 % of patients); blood loss and/or relocation of cannulas. Hypoxia of the upper body (Harlequin syndrome) occurred in 8.8 % of patients. Cannulation failure and malfunction were infrequent. Careful insertion technique, close surveillance and monitoring are compelling.
  
  
  CONCLUSIONS
  As lack of experience is the trigger of many complications, adequate training of cannulation techniques is essential to minimize adverse events.
authors.affiliation: Departmentof Cardiothoracic Surgery.
authors.forename: L
authors.initials: L
authors.lastname: Rupprecht
authors.affiliation: Departmentof Anesthesiology.
authors.forename: D
authors.initials: D
authors.lastname: Lunz
authors.affiliation: Departmentof Cardiothoracic Surgery.
authors.forename: A
authors.initials: A
authors.lastname: Philipp
authors.affiliation: Department of Internal Medicine II/Pneumology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Lubnow
authors.affiliation: Departmentof Cardiothoracic Surgery.
authors.forename: C
authors.initials: C
authors.lastname: Schmid
keywords: ECMO; cannulation; limb ischemia; percutaneous
references.citation: J Thorac Cardiovasc Surg. 2015 May;149(5):1428-33
references.pmid: 25746030
references.citation: Artif Organs. 2009 Sep;33(9):696-703
references.pmid: 19775261
references.citation: J Card Surg. 2014 May;29(3):427-9
references.pmid: 24612315
references.citation: J Am Coll Cardiol. 2014 Jul 1;63(25 Pt A):2769-78
references.pmid: 24814488
references.citation: Cardiology. 2014;129(3):137-43
references.pmid: 25277292
references.citation: Cochrane Database Syst Rev. 2015 Jan 22;1:CD010381
references.pmid: 25608845
references.citation: Interact Cardiovasc Thorac Surg. 2011 Jun;12(6):978-81
references.pmid: 21388980
references.citation: Thorac Cardiovasc Surg. 2009 Dec;57(8):449-54
references.pmid: 20013616
references.citation: Crit Care Med. 2015 May;43(5):1010-5
references.pmid: 25746749
references.citation: Thorac Cardiovasc Surg. 2011 Mar;59(2):103-7
references.pmid: 21384306
references.citation: Minerva Anestesiol. 2016 Jan;82(1):36-43
references.pmid: 25907578
references.citation: Ann Thorac Surg. 2014 Nov;98(5):1853-4
references.pmid: 25441810