Veno‐arteriovenous extracorporeal membrane oxygenation—A single center experience

Background Patients with combined circulatory shock and respiratory failure may benefit from veno‐arteriovenous (V‐AV) extracorporeal membrane oxygenation support (ECMO). We report our center’s experience with V‐AV ECMO and propose an algorithm to help identify patients that may benefit from early V‐AV ECMO support. Methods Clinical data were extracted from electronic medical records between November 1, 2016 and November 1, 2019. Results Out of a total of 369 patients placed on extracorporeal life support (ECLS), we identified a total of 26 patients who underwent hybrid ECMO placement. Three patients were excluded from our analysis due to veno‐venoarterial extracorporeal membrane oxygenation (V‐VA ECMO) configuration, therefore 23 patients were included in our analysis. The median age was 53 (range 25–73) years. Hybrid ECMO support was instituted most commonly for differential hypoxemia in patients on venoarterial (V‐A) ECMO support, and cardiogenic shock in patients who were initially started on venovenous (V‐V) ECMO. The initial ECMO cannulation was V‐A in 12 patients, V‐V in 8 patients, and directly V‐AV in 3 patients. Nine out of 23 patients were successfully decannulated (39.1%) and survived until hospital discharge. The main ECMO‐related complications included bleeding (n = 10), circuit exchange either due to hemolysis or oxygenator failure (n = 4), ECMO cannula site infection (n = 2), deep venous thrombosis (n = 2), and death during ECMO cannula exchange (n = 1). Conclusions V‐AV ECMO represents a rescue strategy in critically ill patients with combined respiratory failure and cardio‐circulatory shock. Out of 369 patients placed on extracorporeal life support between November 1, 2016 and November 1, 2019, we identified a total of 23 patients who underwent V‐AV ECMO placement. The initial ECMO cannulation was V‐A in 12 patients, V‐V in 8 patients and V‐AV in 3 patients. Nine out of 23 patients were successfully decannulated (39.1%) and survived to hospital discharge. In conclusion, V‐AV ECMO represents a rescue strategy in critically ill patients with combined respiratory failure and cardio‐circulatory shock. ECMO, extracorporeal membrane oxygenation; V‐A, venoarterial; V‐AV, veno‐arteriovenous; V‐V, venovenous; V‐VA, veno‐venoarterial.