Reliable Flow, Cost-Effective, Comfortable: Tunneled Veno-Pulmonary Artery Extracorporeal Membrane Oxygenation Cannulation Technique

Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) has many limitations, including patient comfort and, oftentimes, mobility issues. Veno-pulmonary (VP) ECMO offers respiratory support without recirculation and right heart support. For longer mechanical circulatory support (MCS) and improved mobility, non-femoral cannulation is preferred. The current standard is a double-lumen single-cannula via the right internal jugular vein. This requires cannula fixation to the head with a headband, which limits head movement and is uncomfortable due to its size. Flow fluctuations can also occur with cannula position. To address the limitations of VV ECMO and dual-lumen single-cannula PV ECMO, we developed a VP ECMO tunneling technique similar to tunneled catheters, utilizing two separate cannulae. Ten patients underwent this procedure at our institution with zero complications, vascular injuries, or cannula kinks. Maximum flow reached 5.2 L/min. Patients maintained head mobility and upper extremity function comfortably over a month period. This technique improves patient comfort, ensures stable cannula position, maintains reliable flow, and is cost-effective.