Commentary: Walking wounded: Role of ambulatory femoral venovenous extracorporeal membrane oxygenation

Abstract

Venovenous extracorporeal membrane oxygenation (VV-ECMO) can support patients with respiratory failure refractory to mechanical ventilation and optimal medical therapy. Conventional VV-ECMO can be achieved by placement of 2 single-lumen cannulae: typically a femoral vein drainage cannula and a jugular vein reinfusion cannula. This strategy generally requires the patient to be bedridden to avoid potential cannula displacement and/or catastrophic bleeding complications. Patients who require prolonged VV-ECMO support for any cause are thus at high-risk of profound physical deconditioning, which is associated with longer hospital stays, severe neuromuscular weakness, and results in poorer general outcomes. This is of particular relevance in patients awaiting lung transplant, for whom pretransplant physical condition largely influences recovery. In 2010, Garcia and colleagues reported the first case of ambulatory VV-ECMO using the Avalon (Getinge AB, G€oteborg, Sweden) dual-lumen cannula inserted through the right internal jugular vein. Since then, alternative surgical techniques using central or upper body cannulation strategies for VV and venoarterial (VA) ambulatory ECMO have been described. In a review article, the authors conclude that ambulatory VV-ECMO could be a be safe approach in high-volume centers, and may provide