Modifying a traditional femoral venoarterial extracorporeal membrane oxygenation cannulation strategy and circuit to improve distal limb hemodynamics

Objective: There have been many varied approaches to support patients on femoral venoarterial extracorporeal membrane oxygenation (ECMO), yet limb ischemia remains a significant problem. Using a dynamic mock flow loop model, we modified a historically traditional cannulation strategy and circuit (TC) to a proposed "hemodynamically ideal" configuration (HIC) to improve distal limb hemodynamics. Methods: A dynamic mock flow loop model was tuned to simulate heart failure. Two femoral venoarterial ECMO configurations were tested: (1) For TC, 19-Fr arterial cannula (right common femoral artery) with ipsilateral venous cannulation (right femoral vein), and an 8-Fr introducer sheath as the distal perfusion catheter (right superficial femoral artery) with its line T'd from the arterial cannula's Luer port. (2) Proposed HIC: A smaller arterial cannula (15 Fr, right common femoral artery) with contralateral venous cannulation (left femoral vein), and a 10-Fr pediatric arterial cannula as the distal perfusion catheter (right superficial femoral artery) with its line Y'd from the ECMO circuit. Experiments were performed at baseline and with ECMO support at 0, 1000, 2000, and 3000 rpm. Results: The proposed HIC reduced ventricular afterload and provided greater pulsatility and flows to the distal limbs, particularly to the cannulated right superficial femoral artery. The HIC also provided 390% more distal perfusion catheter flow than the TC. Conclusions: The proposed HIC provided more favorable hemodynamics compared with a TC that may offer significant clinical benefits, including less congestion, reduced risk of limb ischemic, and improved patient outcomes, warranting further clinical investigation.