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