Why the study?
Patients on VV ECMO may develop cardiovascular dysfunction requiring hemodynamic support, while patients on VA ECMO may need additional respiratory support, prompting evaluation of a hybrid venoarterio-venous configuration.
VA-V ECMO is a feasible configuration for patients with combined cardiopulmonary failure or differential hypoxemia, demonstrating a 64% survival to hospital discharge in this small cohort.
Patients in respiratory failure on VV ECMO may develop cardiovascular dysfunction necessitating additional hemodynamic support, while patients in cardiovascular failure on VA ECMO may require additional respiratory support for concurrent gas exchange abnormalities. A hybrid venoarterio-venous (VA-V) configuration provides both cardiac support via a traditional arterial reinfusion cannula and respiratory support via an additional venous reinfusion limb. We describe our single center experience using VA-V ECMO for patients (n = 14, median age 54) with combined cardiopulmonary failure or differential hypoxemia. Patients were treated with ECMO support for a median of 148.2 (IQR 122.6 – 174.4) hours, consisting of 0 (IQR 0 – 1.8) hours of VA and 92.4 (IQR 58 – 115) hours of VA-V followed by 46 (IQR 0 – 95.5) hours of VV support. Of these 14 patients, 11 survived to decannulation (79%) and 9 survived to hospital discharge (64%).
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Kukielski et al. (2021) studied this question.
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