Surgical technique
The cannulation of VA-ECMO was performed under general anesthesia and mechanical ventilation in 99% of cases. The implanting team included two surgeons (senior and resident), a scrub-nurse, a perfusionist and an anesthetist. All required material was available on a dedicated trailer, allowing full autonomy for prompt displacement of the team within-hospital facilities wherever ECMO support was needed, including operative theatre, intensive care units (ICUs) and catheterization room.
Peripheral cannulation through the femoral access was most commonly employed (94.4%). The anterior surface of the right common femoral artery and vein was exposed through groin incision and cannulated using the Seldinger technique (16–20 Fr for the inflow cannula and 18–32 Fr for the drainage cannula, according to the patient’s body surface area, vessels quality and surgeon’s preference) (Edwards Lifesciences, Inc., Irvine, CA, USA). In all peripheral VA cases, a reperfusion catheter was introduced in the superficial femoral artery to prevent limb ischaemia (5–10 Fr). The left groin was accessed in case of unsuitable vascular access on the right side. VA-ECMO cannulation was performed in the cardiac surgery operating theatre if the patient could be safely transported (71.2%). In case of unstable haemodynamics or cardiac arrest, cannulation was done at the patient’s bed (18.0%) Removal of the VA-ECMO cannulae was performed in the operating theatre (except in case of death under support) to allow optimal vessel repair. A few post-cardiotomy patients (n = 32, 5.6%) received central ECMO with a left atrial vent through median sternotomy.