Optimal Position of a Femorojugular Cannulation for Venovenous Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome

BACKGROUND This study aimed to determine the optimal position of venovenous extracorporeal membrane oxygenation (V-V ECMO) draining cannulas for refractory respiratory failure based on short-term clinical results.METHODS In total, 278 patients underwent V-V ECMO at our hospital between 2012 and 2020. Those who underwent V-V ECMO with a femorojugular configuration were included. In the final cohort, 96 patients were divided into groups based on the draining cannula tip site: an inferior vena cava (IVC) group (n = 35) and a right atrium (RA) group (n = 61). The primary outcome was the change in fluid balance and ratio of awake ECMO 72 hours after V-V ECMO initiation.RESULTS The only significant difference in baseline characteristics before V-V ECMO between the groups was a higher PaO2/FiO2 ratio in the RA group than in the IVC group (79.1 +/- 26.21 vs 64.7 +/- 14, P = .001). The degree of recirculation and arterial oxygenation, 90-day mortality, and clinical outcomes were similar between the groups. However, more patients achieved negative intake and output fluid balances (57.4% vs 31.4%, P = .01) and reductions in body weight (68.9% vs 40%, P = .006) in the RA group. At 72 hours after Vfemoral-Vjugular ECMO initiation, more patients in the RA group than in the IVC group were managed under awake ECMO (42.6% vs 22.9%, P =.047).CONCLUSIONS Placement of a V-V ECMO draining cannula in the RA rather than the IVC is more effective for restricted fluid management and awake ECMO without significant recirculation.

Automated summary

This study aimed to determine the optimal position of venovenous extracorporeal membrane oxygenation (V-V ECMO) draining cannulas for refractory respiratory failure based on short-term clinical results. The results showed that placing the V-V ECMO draining cannula in the right atrium (RA) instead of the inferior vena cava (IVC) is more effective for restricted fluid management and awake ECMO without significant recirculation, with similar arterial oxygenation, 90-day mortality, and clinical outcomes between the groups.