Chest

Chest

Volume 115, Issue 3, March 1999, Pages 818-822
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Clinical Investigations in Critical Care
Venovenous Extracorporeal Life Support Via Percutaneous Cannulation in 94 Patients

https://doi.org/10.1378/chest.115.3.818Get rights and content

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 cannulation.

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.

Section snippets

Materials and Methods

From May 1992 to November 1997 at the University of Michigan Medical Center, 94 adult patients > 17 years old with severe respiratory failure were placed on venovenous ECLS utilizing a percutaneous vascular access technique. Our ECLS management technique in the setting of adult respiratory failure has been previously described.5,6 Percutaneous vascular access was obtained using a modified Seldinger technique. Both the right neck and either inguinal region were aseptically prepped and draped.

Results

One hundred eighty-eight percutaneous cannulation attempts were performed in 94 patients. In seven cases, we were unable to access the vein with a needle: six in the internal jugular vein and one in the FV. A direct cutdown on the vessel was required for cannulation in these instances. In three cases, the femoral artery was injured during the percutaneous cannulation, and a cutdown was required for the repair of the artery and the subsequent venous cannulation. In one case, the jugular vein was

Discussion

Extrathoracic cannulation for partial cardiopulmonary bypass was described in the late 1960's as a safe method for the stabilization of critically ill cardiac surgery patients during the induction of general anesthesia.11,12,13 This technique generally involved the cutdown and cannulation of the femoral artery and vein under local anesthesia. In the 1970's, Bartlett et al14 described a technique of extrathoracic cannulation for venoarterial bypass to support gas exchange in newborn infants with

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    Copyright © 1999 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.