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Clinical Investigations in Critical Care |

Venovenous Extracorporeal Life Support Via Percutaneous Cannulation in 94 Patients*

Thomas Pranikoff, MD; Ronald B. Hirschl, MD; Robert Remenapp, RRT; Fresca Swaniker, MD; Robert H. Bartlett, MD, FCCP
Author and Funding Information

*From the Department of Surgery, The University of Michigan Medical School, Ann Arbor, MI.



Chest. 1999;115(3):818-822. doi:10.1378/chest.115.3.818
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Study objective: The objective of this study was to demonstrate the safety and utility of a method of percutaneous access for cannulation of adult patients for venovenous extracorporeal life support (ECLS).

Design: A retrospective review of a patient series.

Setting: A surgical ICU at a university teaching hospital.

Patients: The study group consisted of 94 adults > 17 years old with respiratory failure who were placed on venovenous ECLS by means of percutaneous cannulation.

Interventions: The cannulation of the internal jugular and femoral veins (FVs) using the Seldinger technique for venovenous ECLS.

Measurements and results: Between May 1992 and November 1997, we performed percutaneous cannulation for venovenous ECLS in 94 adult patients with respiratory failure. The mean (± SD) age was 36.1 ± 12.7 years old (range, 17 to 65 years). The mean (± SD) weight was 80.7 ± 22.3 kg (range, 36 to 156 kg). The right internal jugular vein (RIJV) was used for venous drainage access in all but four cases. The right FV (n = 86), the left FV (n = 3), or the RIJV (n = 4) was utilized for venous reinfusion. The maximum blood flow (± SD) during ECLS was 57.6 ± 17.5 mL/kg/min (range, 22.4 to 127.8 mL/kg/min), with a postmembrane outlet pressure (± SD) of 146 ± 43 mm Hg (range, 56 to 258 mm Hg) at the maximum flow rate. There were 11 unsuccessful percutaneous cannulation attempts. In three patients (3%), the complications consisted of arterial injury requiring operative cutdown and repair. In six patients (6%), cannula-site bleeding required pursestring suture reinforcement of the cannula site. One patient died from the perforation of the superior vena cava during cannulation.

Conclusions: Based on these data, we conclude that percutaneous cannulation may be utilized to provide venovenous ECLS in adults.

Abbreviations: AF = atriofemoral; ECLS = extracorporeal life support; FA = femoroatrial; FV = femoral vein; PAC = pulmonary artery catheter; RIJV = right internal jugular vein; SVC = superior vena cava


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