VA ECMO Cannulation Technique via the Axillary Artery and Femoral Vein

Thank you for the informative video. I cannulated one adult ECMO patient with axillary approach. The patient developed a lot of right arm edema. How do you manage this issue?

This is unfortunately a very common problem. Prior to starting the operation, I always place arterial lines in both upper extremities to monitor the pressure on either side. After placing my axillary graft, I routinely place an umbilical tape around the distal axillary artery and attach it to a snare that I exit through a skin stab wound a few centimeters below the axillary incision. I then place a clamp on the snare here. Once the patient is on ECMO, I snare down on the umbilical tape to achieve a MAP < 120 on the axillary cannulation side. In all the patients I have treated this way, I have not noticed RUE swelling. Postoperatively, the snare allows you to titrate the tension to achieve the MAP for which you are aiming, since the RUE perfusion tends to fluctuate. I would be interested in any other solutions that surgeons have come up with to address this problem. Clinically it can be confusing when the RUE swells, since it is often challenging to distinguish arm hyperperfusion from an axillary vein DVT or a dissecting hematoma in the arm. Thanks again for a great question, Dr. Egrie.