Venovenous ECMO relies upon drainage of venous blood from the body and then a return of blood that has been oxygenated to the venous circulation. If the sites of venous drainage and return of oxygenated blood are too close, mixing can occur between the cannulae. Thus, the tips of the two cannula should be separated.
Blue lines denote drainage cannulas, which deliver venous blood from the patient to the membrane oxygenator. Red lines denote return cannulas, which deliver oxygenated blood from the membrane oxygenator to the patient.
(A) Femoral-right internal jugular cannulation.
(B) Dual-lumen right internal jugular cannulation with Avalon Elite cannula. With this cannula, drainage occurs in the SVC and IVC, and blood is returned to the RA.
(C) Femoral-femoral cannulation with the return cannula at the junction of the IVC and RA and drainage in the IVC.
(D) Femoral-femoral cannulation with the return cannula in the RA and the drainage cannula in the femoral vein and distal IVC. Femoral cannulae are inserted into the femoral vein, which drains into the common iliac vein.
From: Fierro MA, Daneshmand MA, Bartz RR. Perioperative management of the adult patient on the venovenous extracorporeal membrane oxygenation requiring noncardiac surgery. Anesthesiology 2018; 128:181. DOI:
10.1097/ALN.0000000000001887. Copyright © 2018 American Society of Anesthesiologists. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.
