Case Reports

Variability in End-Organ Perfusion with Femoral-Femoral Venoarterial Extracorporeal Membrane Oxygenation: Aortographic Evidence

^* Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York
^† Department of Perioperative Services, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
^‡ Department of Medicine, Weill Cornell Medical College, New York, New York

Address correspondence to: Arash Salemi, MD, FACS, FACC, Associate Professor of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medical College, 525 East 68th Street, M-404, New York, NY 10065. E-mail: ars9001@med.cornell.edu

Received: 26 November 2014
Accepted: 31 January 2015

Abstract

In femoral-femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO), the outflow of oxygenated blood from the circuit enters the aorta in retrograde fashion. As a result, variability in end-organ oxygenation (e.g., cerebral vs. splanchnic) may arise—particularly, when the heart is unable to contribute forward flow. We present the case of a 74-year-old man supported by femoral-femoral VA-ECMO in whom aortography was used to visualize the retrograde distribution of arterial ECMO flow that can produce such differences in end-organ perfusion. We do this by describing a series of still images captured during the aortography; we then discuss the importance of monitoring end-organ oxygenation in this setting and outline several interventions that can ameliorate this flow phenomenon.