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Right Cervical Cannulation for VA-ECMO Support

Thursday, January 23, 2014

By

Giuseppe Pelella

In this video, the authors show how to start veno-arterial ECMO support (VA-ECMO) through cervical cannulation, using the right internal jugular vein and right common carotid artery. This site is chosen over the femoral approach, as it avoids the associated complications, particularly in newborns and non-walking infants. In patients who require ECMO after a cardiac operation, an initial transthoracic approach is established. Cervical cannulation is a method to move the cannulas away from the chest, and to allow delayed chest closure in such patients, while continuing ECMO support. Cervical cannulation can be performed at the bedside, in an emergency setting, and during cardiac massage.

Comments

Submitted by Khanh Nguyen on
Greetings from New York. From the video, both right carotid artery and internal jugular vein are ligated. Have you used pursetrings for cannulation and restored flow to both vessels after decannulation? The prospect of preserving two patent carotid arteries is apealing and in fact is our practice in ECMO cannulation in neonates and infants. Thank you for a very nice video. Khanh Nguyen ,MD.
Submitted by Giuseppe Pelella on
We have found that cannulae secured with a purse string are less stable and are more likely to be accidentally dislodged. Stability of the cannula is important for patients needing ECMO for weeks. It is our practice to reconstruct both vessels at the time of the decannulation with a transverse suture line if the edges of the incision are free from evidence of local infection. Otherwise we perform an excision of both the stumps and then an end to end anastomosis to restore the flow. Rarely, if the reconstruction is not adequate, we need to clip off the vessel. There is risks of thrombosis and stroke with a technically poor reconstruction.

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