| ECMO type | Description | Advantages | Disadvantages | COVID-19 considerations |
| Venovenous (VV) | Drainage of blood from the venous system with return of oxygenated blood via the venous system | - Easy and quick to establish at bedside
| - Relies on adequate function of the RV and LV
- Subject to recirculation if malpositioned
| - Easiest form of VV ECMO to establish without the need for fluoroscopy
|
| Venoarterial (VA) | Drainage of blood from the venous system with return of oxygenated blood via the arterial system | - May be quickly established at bedside
- Provides oxygenation, ventilation, and biventricular support
| - Limits patient mobility
- Risks compromise of peripheral circulation due to impairment of arterial blood flow distal to the femoral arterial cannula
- High rate of complications requiring surgical interventions
| - Provides both cardiac and pulmonary support for patients manifesting COVID-19-associated myocarditis
|
| Bicaval dual-lumen ECMO | Drainage of blood from cannula ports in the SVC and IVC, with return of oxygenated blood to the RA but directed across the tricuspid valve | - Single catheter
- Allows mobilization
| - Relies on adequate function of the RV and LV
- Subject to recirculation if malpositioned
- Commonly requires fluoroscopy for placement
| - Need for fluoroscopy requires movement to catheterization suite or hybrid operating room risking exposure of additional providers
- Confirmation that oxygenated blood is flowing across TV may require use of TEE (which generates aerosol, although this is less likely in intubated patients)
|
| Atriopulmonary ECMO | Drainage of blood from the venous system via the RA, with return of oxygenated blood to the pulmonary artery | - Single catheter
- Provides RV hemodynamic support
- Allows mobilization
| - Requires fluoroscopy for placement
| - Need for fluoroscopy requires movement to catheterization suite or hybrid operating room, risking exposure of additional providers
- Provision of RV support is advantageous in patients with pulmonary hypertension and COVID-19-associated RV dysfunction
- Temporary FDA approval for use to provide ECMO during COVID-19 crisis
|
