Venovenous extracorporeal life support via percutaneous cannulation in 94 patients

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 eava during cannulation, Conclusions: Based on these data, we conclude that percutaneous cannulation may be utilized to provide venovenous ECLS in adults.