Veno-venous ECMO is a well-established support technique for patients with respiratory failure-induced hypoxia allowing for pulmonary recovery and implementation of lung-protective ventilatory settings. However, in severe respiratory failure cases, ECMO may be unable to provide full support, and patients remain hypoxic. In this case series, we describe the reconfiguration of VV ECMO to veno-veno-venous (VV-V) ECMO, a more complex “hybrid” cannulation strategy, where a third cannula is inserted to improve venous drainage to provide more ECMO blood flow and therefore increase systemic oxygenation in patients receiving ECMO for severe COVID-19.
Data from patients who received circuit reconfiguration from VV ECMO to VV-V ECMO at the Royal Brompton Hospital during the COVID-19 pandemic between March 2020 - February 2021 was collected from the ICU’s Clinical Information System (ICCA, Philips Healthcare) and analysed. Endpoints included PaO2, ECMO blood flow, arterial saturation and any complications relating to the reconfiguration.
17 patients (11/17 male) with an average BMI of 37.6 ± 10.4 received circuit configuration bedside with no recorded complications. A significant increase in ECMO blood flow (average increase 0.57 ± 0.69 LPM, p=<0.01), PaO2 (average increase 4.7 ± 4.15 kPa, p=<0.001) and arterial saturation (10 ± 6%) were demonstrated over the cohort of patients. 13/17 patients survived their ECMO run, 5 patients died during their ECMO run. Patients spent an average of 36.4 days on ECMO.
Reconfiguration of VV ECMO to a VV-V cannulation strategy is a safe procedure and increase ECMO blood flow and therefore, arterial oxygenation and saturation in hypoxic patients with severe COVID-19.
Rosie is experienced in all aspects of adult and paediatric perfusion including ECMO, transplant and complex aortic procedures. Her main clinical interest is ECMO and she is currently the Perfusion Lead for ECMO, working closely with the Clinical ECMO Leads, ECMO nursing Leads and Chief Perfusionist to develop and govern the ECMO practices throughout the services including neonatal/paediatric and the nationally commissioned ECMO for SARF service.nRosie is also particularly interested in Human Factors in the clinical setting and within the role of perfusion, as well as simulation and its important role within eduction of the perfusionist and the clinical team. Click Here for SCPS profile.