Hybrid and parallel extracorporeal membrane oxygenation circuits

Abstract

See Commentaries on pages 86 and 88. Associate Editor Note—Extracorporeal membrane oxygenation (ECMO) has been around since the 1950s and remains a tool for the management of patients with refractory respiratory or circulatory failure. The authors of this Invited Expert Opinion address modifications to traditional circuitry when peripheral cannulation does not appear sufficient and augmentation of venous drainage or ECMO flow is necessary. Although conversion to central cannulation is one option, expansion of the existing circuit to incorporate either a hybrid approach (eg, transitioning from veno-venous ECMO to veno-arteriovenous ECMO in the setting of refractory hypoxia or declining cardiac function) is another option. The descriptions of the techniques, rationale, physiology, potential pitfalls, and outcome data of each approach should serve as an important and handy reference for surgeons involved in the management of these patients.