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Venous-Arterial VA ecmo is most often used for patients with severe cardiac dysfunction, so much to the point that the patient may die without the use of ecmo therapy.
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With VA ecmo all of the patients cardiac support is managed with the ecmo pump.
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The most common routes of VA ecmo are central and peripheral cannulation.
Common issues to think about with VA ecmo:
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Left ventricular distention- this is when there is no contractility in the left ventricle and it fills up like a balloon, this is not good for the left ventricle as we are trying to rest the heart to give it a change to heal on its own.
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North south syndrome- this is a issue with peripheral cannulation and occurs due to retrograde perfusion, movement of the mixing cloud, and native heart contractility.
Key is to have pulse oximetery on the right hand.
Limb Ischemia- this is another issue to think about with peripheral cannulation and retrograde perfusion. Due to cannulation in femoral artery blood flow to the lower and foot is diminished and can cause limb ischemia.
Reperfusion cannula- is the best way to prevent limb ischemia. A reperfusion cannula is bifurcated off the arterial cannula and is attached to perfuse the lower leg and foot.
