ECMO Review
ECMO Circuit Review
VV ECMO
Most common for lung issues such as ARDS
Protec Duo Cannula
This special VV ecmo is used when a patient is in isolated RV failure with oxygenation needs.
VA ECMO
Heart failure, cardiogenic shock, PE. Need to worry about North South syndrome. North being deoxygenated, and South being oxygenated. Also may lead to LV distension in poor outflow states consider VAV or impella or both.
VVA ECMO
VA ecmo with increased drainage may help offload LV distension
VAV ECMO
Combined VV and VA support. May need impella for LV distension
ECMO with LV Impella ie ECPELLA
From the pdf:
VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION (VA-ECMO) commonly is used to support patients with refractory cardiac arrest or cardiogenic shock mainly via percutaneous cannulation.4 This strategy may cause left ventricle (LV) distention that compromises myocardial recovery. Direct LV unloading provided by Impella was associated with lower mortality in patients with cardiogenic shock supported with VA-ECMO in a recent international multicenter study. The present paper has a specific purpose to provide a complete overview of this strategy, starting from a solid pathophysiologic approach. Then, the rationale for unloading the LV and the related available techniques is discussed. Finally, the combined configuration of VA-ECMO and Impella (ECPella) is fully treated, providing its significant clinical applications.