Case presentations demonstrate improved neurological outcomes using VV-ECMO in ECPR patients, suggesting a new approach.
Differential oxygenation may complicate extracorporeal cardiopulmonary resuscitation (ECPR) either due to the initial pathology or subsequent lung injury. The dual circulation phenomenon inherent to peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) risks poorly oxygenated blood preferentially supplying the cerebral circulation. This may be deleterious to neurological outcomes and survival in this cohort. We describe two novel cases of parallel VV-ECMO support following ECPR, using a dual-lumen bicaval cannula to salvage severe differential hypoxemia. Decannulation of arterial support occurred at 4 and 7 days, respectively, with initial reconfiguration to high-flow VV-ECMO. This unique approach offers an attractive alternative to hybrid VAVECMO and may provide a necessary escalation following successful ECPR to facilitate neuroprotection. https://links.lww.com/ASAIO/B896
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Worku et al. (2026) studied this question.
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