Pitfalls in percutaneous ECMO cannulation

INTRODUCTION: This observational report depicts typical problems of extracorporeal membrane oxygenation cannulation from a large case series of a single center. METHODS: We analysed our experience with 720 consecutive patients receiving veno-venous or veno-arterial extracorporeal membrane oxygenation focusing on the spectrum of complications occurring in a subset of 159 patients treated with percutaneous veno-arteria extracorporeal membrane oxygenation in our institution between January 2009 to December 2014. RESULTS: The main problems were: vascular complications or ischemia of the corresponding extremity (leading to surgical revision in 16.9 % of patients); blood loss and/or relocation of cannulas. Hypoxia of the upper body (Harlequin syndrome) occurred in 8.8 % of patients. Cannulation failure and malfunction were infrequent. Careful insertion technique, close surveillance and monitoring are compelling. CONCLUSIONS: As lack of experience is the trigger of many complications, adequate training of cannulation techniques is essential to minimize adverse events.