The technique of intraoperative axillary artery cannulation for extracorporeal membrane oxygenation in lung transplantation

Background: To show our experiences of using the axillary artery with a side graft as a cannulation technique for the inflow of veno-arterial extracorporeal membrane oxygenation (ECMO) in lung transplantation (LTx). This method can avoid complications associated with central and femoral vessel cannulation techniques, and be convenient for the use of intraoperative ECMO into the early postoperative period. Methods: Between November 2016 and July 2017, we established intraoperative V/A-ECMO in 32 patients. Among these patients, 5 patients were performed on via axillary artery-percutaneous femoral vein cannulation (15.6%), 2 patients were performed on with veno-venous ECMO (V/V-ECMO) as a bridge to transplantation with hemodynamic instability during transplantation, and additional axillary artery cannulations were performed to establish veno-veno-arterial (V/V/A) ECMO. Mean age was 45.2 +/- 10.1 years (range, 26-71 years). Results: In 7 patients undergoing ECMO support during operation, the ECMO was removed in 4 patients immediately after the procedure, 3 patients with "prolonged ECMO" were transferred to the ICU. There were no ECMO-related complications and no patients died. Conclusions: Our protocol for V/A-ECMO cannulation that uses the axillary artery for arterial cannulation provides a safe and improved means for delivering V/A-ECMO support during LTx. Also, it is helpful for prolonging the intraoperative ECMO in the early postoperative period.