This interesting study evaluated four central cannulation strategies in an acute sheep model to identify an optimal configuration for ambulatory veno-venous extracorporeal membrane oxygenation (VV-ECMO). Researchers tested custom single-site (SS) and dual-site (DS) systems, draining from the right atrium (RA) and reinfusing either pre-tricuspid (right atrium) or post-tricuspid (right ventricle, RV). During five hours of support, DS configurations demonstrated 0 percent attrition and superior pressure-flow characteristics compared to SS setups. Specifically, the DS-RA-RV setup yielded the lowest average recirculation (22.8 percent) and minimal hemolysis (plasma free hemoglobin 1.7 mg/dL). The authors conclude that a dual-site strategy with RA drainage and RV reinfusion (DS-RA-RV) minimizes recirculation and hemolysis while maximizing technical feasibility, representing the optimal configuration for durable ambulatory VV-ECMO platforms.
