H.7 Redesign of Distal Perfusion in Venous-Arterial ECMO

ECMO, or Extracorporeal Membrane Oxygenation, is a novel technology that uses a pump and oxygenation system to act as either a heart, lungs, or both for a patient who has significant respiratory or cardiac failure. These devices require specialized physicians to place large cannulas into central arteries and veins to drain and return blood to the patient. Patients may be placed on these machines for weeks or months at a time while their organs recover.

We often place arterial cannulas to take over the work of the heart in the femoral artery, called venous-arterial (VA) ECMO, running the cannula upwards into the aorta closer to the heart and providing retrograde flow. However, one side effect of this is that the flow down the leg on the same side is often reduced; to combat this, a second cannula is placed in the superficial femoral artery and part of the flow from the primary cannula is redirected down the leg. Placing this second cannula can be difficult, as this artery is small in some patients, deep in others, and generally requires specialized staff significant time and effort to place.

Failure to place a cannula to leg perfusion can lead to complete loss of the leg in the worst case, and loss of toes or the foot in lesser cases.

The goal of this project is reevaluate methods of providing ECMO flow down a patient’s leg, either with easier placement of these secondary cannula or obviating the need entirely through redesign of the primary cannula