What is the access for Veno-Venous (VV) Extracorporeal Membrane Oxygenation (ECMO)?

From the Guidelines

VV ECMO is typically accessed through large central veins, with the most common configuration being a dual-site approach using the right internal jugular vein for drainage and the femoral vein for return, or a single-site approach with a dual-lumen cannula placed in the right internal jugular vein. The access for Veno-Venous (VV) Extracorporeal Membrane Oxygenation (ECMO) involves draining blood from the venae cavae via a femoral venous or right internal jugular venous cannula, as described in the position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients 1. Key considerations for VV ECMO access include:

• The use of large central veins for cannulation
• The option for a dual-site approach using the right internal jugular vein for drainage and the femoral vein for return
• The alternative use of a single-site approach with a dual-lumen cannula placed in the right internal jugular vein
• The importance of proper positioning using imaging guidance, such as ultrasound, fluoroscopy, or echocardiography, to ensure adequate blood flow and prevent recirculation, as this directly impacts patient outcomes in terms of morbidity, mortality, and quality of life. The choice between dual-site and single-site cannulation depends on factors including the patient's anatomy, the experience of the team, and the specific clinical scenario, with the goal of minimizing complications and optimizing patient outcomes 1.

From the Research

Access for Veno-Venous (VV) Extracorporeal Membrane Oxygenation (ECMO)

• The typical insertion site for dual-lumen cannulas for VV ECMO is the right internal jugular vein (RIJV) 2, 3, 4.
• However, alternative venous access sites can be used if the RIJV is inaccessible, including:
  • Left internal jugular vein 2, 5
  • Right or left subclavian vein 2
  • Right or left femoral vein 2, 6
  • Axillary vein 6
• These alternative sites have been shown to be safe and feasible for VV ECMO support, with no significant differences in blood flow or gas exchange compared to the traditional RIJV approach 2, 6, 5.
• The use of bicaval dual-lumen catheters has also been described, which can be inserted through the right or left internal jugular vein and provides simultaneous venous drainage and reinfusion of blood 3, 5, 4.
• Ultrasound-guided percutaneous cannulation can reduce cannulation failure and mechanical complications, and is considered a safe and effective approach for VV ECMO cannulation 6, 4.