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Diagram depicting the progression of the extracorporeal membrane oxygenation (ECMO) cannulation in this patient. a Veno-venous (VV) ECMO: drainage cannula in the left femoral vein, return cannula in the right internal jugular vein. b Veno-veno-venous ECMO: drainage cannula in the left femoral vein and right femoral vein, return cannula in the right internal jugular vein. c Parallel veno-venous and veno-arterial (VA) ECMO. VV: drainage cannula in the left femoral vein, return cannula in the right internal jugular vein. VA: drainage cannula through right femoral vein, return cannula in the right femoral artery
Source publication
Background
The complexity of extracorporeal membrane oxygenation (ECMO) techniques continues to evolve. Different cannulation methods and configurations have been proposed as a response to a challenging cardiovascular and pulmonary physiology of the patients. The use of parallel ECMO circuits represents a unique and novel approach for patients with...
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Citations
... (8) Navas-Blanco et al. described the successful association of venoarterial and VV-ECMO in a patient with associated severe cardiovascular and respiratory failure. (23) Hamilton et al., (10) Gygax et al. (13) and Lonsky et al. (12) described the successful use of an in-parallel association of oxygenators during cardiopulmonary bypass in very obese patients. Kelli et al. experimentally described the in-parallel association of oxygenators as effective in improving oxygenation in situations with a low rate of blood flow. ...
Objective:
To characterize the pressures, resistances, oxygenation, and decarboxylation efficacy of two oxygenators associated in series or in parallel during venous-venous extracorporeal membrane oxygenation support.
Methods:
Using the results of a swine severe respiratory failure associated with multiple organ dysfunction venous-venous extracorporeal membrane oxygenation support model and mathematical modeling, we explored the effects on oxygenation, decarboxylation and circuit pressures of in-parallel and in-series associations of oxygenators.
Results:
Five animals with a median weight of 80kg were tested. Both configurations increased the oxygen partial pressure after the oxygenators. The return cannula oxygen content was also slightly higher, but the impact on systemic oxygenation was minimal using oxygenators with a high rated flow (~ 7L/minute). Both configurations significantly reduced the systemic carbon dioxide partial pressure. As the extracorporeal membrane oxygenation blood flow increased, the oxygenator resistance decreased initially with a further increase with higher blood flows but with a small clinical impact.
Conclusion:
Association of oxygenators in parallel or in series during venous-venous extracorporeal membrane oxygenation support provides a modest increase in carbon dioxide partial pressure removal with a slight improvement in oxygenation. The effect of oxygenator associations on extracorporeal circuit pressures is minimal.
... (8) Navas-Blanco et al. descreveram a associação bem-sucedida de venoarterial e VV-ECMO em um paciente com insuficiência cardiovascular e respiratória grave associada. (23) Hamilton et al., (10) Gygax et al. (13) e Lonský et al. (12) descreveram o uso bem-sucedido de uma associação de oxigenadores em paralelo durante a circulação cardiopulmonar em pacientes muito obesos. Kelli et al. descreveram experimentalmente a associação de oxigenadores em paralelo como eficaz para melhorar a oxigenação em situações de pouco fluxo sanguíneo. ...
Objective
To characterize the pressures, resistances, oxygenation, and decarboxylation efficacy of two oxygenators associated in series or in parallel during venous-venous extracorporeal membrane oxygenation support.
Methods
Using the results of a swine severe respiratory failure associated with multiple organ dysfunction venous-venous extracorporeal membrane oxygenation support model and mathematical modeling, we explored the effects on oxygenation, decarboxylation and circuit pressures of in-parallel and in-series associations of oxygenators.
Results
Five animals with a median weight of 80kg were tested. Both configurations increased the oxygen partial pressure after the oxygenators. The return cannula oxygen content was also slightly higher, but the impact on systemic oxygenation was minimal using oxygenators with a high rated flow (~ 7L/minute). Both configurations significantly reduced the systemic carbon dioxide partial pressure. As the extracorporeal membrane oxygenation blood flow increased, the oxygenator resistance decreased initially with a further increase with higher blood flows but with a small clinical impact.
Conclusion
Association of oxygenators in parallel or in series during venous-venous extracorporeal membrane oxygenation support provides a modest increase in carbon dioxide partial pressure removal with a slight improvement in oxygenation. The effect of oxygenator associations on extracorporeal circuit pressures is minimal.
Keywords:
Acute respiratory distress syndrome; Extracorporeal membrane oxygenation; Hypoxia; Hypercapnia; Decarboxylation; Oxygenators; Swine
Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a lifesaving technique for patients experiencing respiratory failure. When VV ECMO fails to provide adequate support despite optimal settings, alternative strategies may be employed. One option is to add another venous cannula to increase venous drainage, while another is to insert an additional arterial return cannula to assist cardiac function. Alternatively, a separate ECMO circuit can be implemented to function in parallel with the existing circuit. We present a case in which the parallel ECMO method was used in a 63-year-old man with respiratory failure due to coronavirus disease 2019, combined with cardiac dysfunction. We installed an additional venoarterial ECMO circuit alongside the existing VV ECMO circuit and successfully weaned the patient from both types of ECMO. In this report, we share our experience and discuss this method.
