Cannulation and decannulation techniques for neonatal ECMO

Published:November 17, 2022DOI:


      • ECMO continues to be an important method of cardiovascular support when conventional treatments are inadequate.
      • Both VA-ECMO and VV-ECMO are suitable options for ECLS, with modality dependent on indication.
      • For VA-ECMO cannulations, cannula location may be confirmed with echocardiography in cases of altered anatomy.
      • For VV-ECMO cannulation, placement should be guided by fluoroscopy or echocardiography and confirmed with echocardiography.
      • For VA-ECMO, some centers perform carotid ligation while some repair the vessels. Data suggest that there is minimal difference in neurological outcomes with either of these practice patterns.
      • All ECMO cannulae have risk of cardiac or vascular complications and need for repositioning. Continued product innovation will be crucial to decrease these inherent risks.
      • Further randomized controlled trials are needed to determine whether there truly is a difference between ligation and repair of the carotid artery with VA-ECMO
      • More prospective data are needed to quantify the potential advantages and expanding use of VV-ECMO in those patients who might otherwise be supported by VA-ECMO


      In neonates with cardiac and/or respiratory failure, extracorporeal membrane oxygenation (ECMO) continues to be an important method of respiratory and/or cardiovascular support where conventional treatments are failing. ECMO cannulation involves a complex decision-making process to choose the proper ECMO modality and cannulation strategy to match each patient's needs, unique anatomy, and potential complication profile. Initially, all ECMO support involved cannulating both the carotid artery and the internal jugular vein (IJV), known as veno-arterial (VA-ECMO) for cardiac and/or respiratory support. Rarely was cannulation through the chest used. The development of dual-lumen cannulae in the early to mid 1990s addressed the concerns about carotid artery ligation and its impact on neurological outcomes, and allowed single vascular access for veno-venous respiratory support (VV-ECMO). We present a review of cannulation and decannulation techniques for both VA and VV-ECMO in neonates.



      ECMO (Extracorporeal Membrane Oxygenation), ECLS (Extracorporeal Life Support), VA (Venoarterial), VV (Venovenous), IJV (Internal Jugular Vein)
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