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Open and closed chest extrathoracic cannulation for cardiopulmonary bypass and extracorporeal life support: methods, indications, and outcomes

¹ Cardiothoracic Centre, Liverpool, UK
² Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, UK

Correspondence to:
Correspondence to:
MrM L Field
Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK; mlfield{at}doctors.net.uk

Extrathoracic cannulation to establish cardiopulmonary bypass has been widely applied in recent years and includes: (a) repeat surgery, (b) minimally invasive surgery, and (c) cases with diseased vessels such as porcelain, aneurysmal, and dissecting aorta. In addition, the success and relative ease of peripheral cannulation, among other technological advances, has permitted the development of closed chest extracorporeal life support, in the form of cardiopulmonary support and extracorporeal membrane oxygenation. With this development have come applications for cardiopulmonary bypass based support outside the traditional cardiac theatre setting, including emergency circulatory support for patients in cardiogenic shock and respiratory support for patients with severely impaired gas exchange. This review summarises the approach to extrathoracic cannulation for the generalist.

Abbreviations: CPB, cardiopulmonary bypass; CPS, cardiopulmonary support; ECLS, extracorporeal life support; ECMO, extracorporeal membrane oxygeneration; TOE, transoesophageal echocardiography; VAVR, vacuum assisted venous return; KAVR, kinetic assisted venous drainage; MAVD, modified assisted venous drainage

Keywords: cannulation; cardiopulmonary bypass; extracorporeal life support

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