Arterial graft cannulation for extracorporeal cardiopulmonary resuscitation

Excerpt

A 62-year-old man presented to the emergency department in refractory ventricular fibrillation out-of-hospital cardiac arrest and was evaluated for extracorporeal cardiopulmonary resuscitation (ECPR). Recent imaging demonstrated a total occlusion of the infrarenal aorta, with previous placement of a bifemoral–axillary bypass graft (Fig. 1A). Thus, we cannulated the patient with a right femoral/graft 17 French arterial cannula (Fig. 1B) and a right femoral 25 French venous cannula (Fig. 1C), with placement of a 5 French distal perfusion catheter (Fig. 1D) for venoarterial extracorporeal membrane oxygenation (VA ECMO). As shown in supplementary Figure S2, we cannulated the graft at a level that still allowed blood flow to the left leg via the femoral–femoral graft, while, in fact, establishing femoral–axillary VA ECMO support via peripheral cannulation. Cannulation for initiation of ECMO despite  total occlusion of the infrarenal aorta that has been surgically bypassed is feasible and is indeed not an absolute contraindication for ECPR.

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