ECMO Cannulation and Configuration

Extracorporeal membrane oxygenation (ECMO) has increasingly been used for patients suffering from severe cardiac or respiratory failure as well as combined cardiopulmonary failure. Establishing ideal ECMO therapy begins with choosing which ECMO configuration to use and uneventful implantation. Nevertheless, cannulation techniques should be tailored to specific patient conditions to ensure sufficient regional and systemic perfusion, which must be monitored comprehensively. There are, however, times when patient status may change or an insufficient amount of ECMO support may occur. This requires a reappraisal of the cannulation strategy and circuit configuration. ECMO configuration and cannulation changes may be dictated by this dynamic management, which is based on end-organ perfusion and patient requirements. Thus, hybrid configurations may represent an essential part of optimal ECMO management towards optimal and successful temporary support and represent a considerable difference from basic configurations. In this chapter, we review the literature and evaluate cannulation strategies and circuit arrangements for adult ECMO, highlighting more complex patterns required in some specific clinical situations.