Surgical cannulation: Indication, technique, and complications

The establishment of ECMO support could be achieved through intrathoracic or extrathoracic cannulation strategies. Central cannulation requires a surgical approach, a sternotomy, and the cannulation of the right atrium and the ascending aorta. The features listed above make the central cannulation the best approach for patients with postcardiotomy complications. Such a cannulation strategy allows the best venous drainage and an anterograde blood flow in ascending aorta; it is though related to important complications such as bleeding and mediastinitis. In case of peripheral cannulation, it is necessary to choose among several sites: femoral vessels, axillary vessels, and cervical vessels are the most used ones. Peripheral vessel cannulation could be achieved either by percutaneous procedures or surgical incisions through an open approach with different techniques (direct cannulation or cannulation with side graft), a semi-Seldinger, or a full Seldinger method. The surgical approach allows the visualization of the vessels, the direct placement of the cannulas, and the control of possible complications. Therefore, it is recommended if immediate support is needed or if a peripheral vascular disease is suspected. Also a mixed central/peripheral cannulation approach is possible. The best cannulation technique should be chosen on the basis of patients and the clinical settings. Moreover, it is necessary to assess benefits and risks of the selected options to pick the best site and strategy of the cannulation.