Table 4 Special considerations for V-V, V-A and V-VA ECMO use in COVID‐19 [22]
Items | Explanation | |
|---|---|---|
V-V ECMO | (1) Large multi-stage, drainage cannula is recommended (e.g. 23 Fr or 11 greater for adults) | It's possible to minimize the need for insertion of an additional drainage cannula at later stage |
(2) Dual lumen cannula should be avoided if possible | Dual lumen cannula is relatively difficult to insert, is associated with higher risk of thrombotic complications and malpositioning requiring repeat echocardiography | |
(3) It's recommended that either the femoro-femoral or femoro-internal jugular configuration be used | The femoro-femoral approach allows for more rapid surgical field preparation, creates efficiency of movement around the bed, and keeps the operator away from the patient's airway | |
V-A and V-VA ECMO | (1) A femoro-femoral configuration for V-A ECMO cannulation is recommended | |
(2) A distal limb perfusion catheter is strongly recommended to reduce the risk of limb ischemia | ||
(3) It's recommended to place three separate single lumen cannulas for the utilization of V-VA ECMO and not recommended to use a double lumen cannula for V-VA ECMO | ||
(4) The initiation of V-VA ECMO as a pre-emptive strategy is not recommended | If a patient requires V-V ECMO but has no evidence of cardiac dysfunction or cardiac dysfunction is medically supportable with inotropes, placement of an arterial cannula is strongly discouraged |