From the Guidelines
Extracorporeal membrane oxygenation (ECMO) primarily comes in two types: veno-arterial (VA) ECMO and veno-venous (VV) ECMO, with VA ECMO providing both cardiac and respiratory support and VV ECMO providing only respiratory support. These types are distinguished by their support functions, with VA ECMO used for patients with cardiogenic shock, cardiac arrest, or severe cardiac failure, and VV ECMO used for severe respiratory failure when mechanical ventilation is insufficient 1.
Key Characteristics of ECMO Types
- VA ECMO: Provides both cardiac and respiratory support by removing deoxygenated blood from a vein and returning oxygenated blood to an artery.
- VV ECMO: Provides only respiratory support by removing blood from a vein and returning oxygenated blood to another vein.
Additional Configurations and Classifications
- Hybrid configurations like veno-arterial-venous (VAV) ECMO combine elements of both VA and VV ECMO for patients with both cardiac and respiratory failure.
- ECMO can also be classified by cannulation approach (central vs. peripheral) and by patient age (neonatal, pediatric, or adult) 1.
Management Considerations
- The choice of ECMO type depends on the specific organ support needed, the patient's condition, and anatomical considerations.
- ECMO requires specialized teams for management, including precise anticoagulation with heparin to prevent circuit clotting while minimizing bleeding risks 1.
Clinical Implications
- Understanding the different types of ECMO and their applications is crucial for healthcare professionals to provide appropriate care for patients supported by ECMO.
- The management of ECMO, including anticoagulation strategies, is complex and requires careful consideration of the risks of thrombosis and bleeding 1.
From the Research
Types of ECMO
- Veno-arterial (VA) ECMO: used to support patients with cardiac and/or pulmonary failure 2, 3, 4, 5, 6
- Veno-venous (VV) ECMO: used to support patients with respiratory failure, can maintain sufficient respiratory support when introduced to respiratory failure patients lacking evidence of renal and/or heart failure 3, 4, 5, 6
Comparison of VA and VV ECMO
- VA ECMO is associated with higher rates of gastrointestinal bleeding and hemolysis compared to VV ECMO 4
- VV ECMO is associated with higher survival rates compared to VA ECMO in adult patients with acute respiratory distress syndrome (ARDS) 4
- In pediatric patients, cannulation type (VA or VV ECMO) is not independently associated with survival to hospital discharge 5
- In neonatal patients, VA ECMO has a cumulative survival of 71% and VV ECMO has a survival of 84% 6