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PedsCrit

VV ECMO Part 2: Cannulation & ventilator strategy

May 1, 2023
Jenna Miller, MD and Dr John Daniel discuss the different cannulas used in VV ECMO, the importance of proper cannula placement, and the risks associated with movement. They also explore the benefits of lung rest and extubation strategy for respiratory kids on ECMO, along with important aspects such as neurosedation, bottle feeding, and monitoring cannula placement.
32:17

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Quick takeaways

  • Proper cannulation technique is crucial for VV ECMO in neonates to avoid complications and ensure effective oxygenation.
  • Rest settings in VV ECMO should be personalized based on patient age and condition, with close monitoring of the right ventricle to prevent RV failure.

Deep dives

Selecting and positioning cannulas for VV ECMO

When cannulating pediatric and neonatal patients for VV ECMO, the most common approach is to cannulate through the right internal jugular vein using a dual-lumen bicable cannula, such as the Avalon. The size of the cannula should be determined based on the patient's body weight and desired flow characteristics. It is important to ensure proper cannula length for patients who are underweight or overweight. While single-site bicable cannulas are most commonly used, there is emerging literature on the use of multi-site VV cannulation, although it is less common and more challenging. Echo guidance is crucial for positioning the cannulas correctly, ensuring that the re-infusion port is oriented towards the tricuspid valve to avoid venous admixture and desaturation.

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