Figure 6.
Multiple circuit extracorporeal membrane oxygenation for high oxygen delivery. Two independently working parallel veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) systems (circuit + console). In addition to typical femoro-femoral VA application (lower circuit in figure), a second ECMO system is applied using jugular drainage from the superior vena cava with return to aortic arch via the right axillar or subclavian artery. This approach has been anecdotally used in hyperkinetic stage of septic shock and provides extra support to circulation and eliminates the risk of oxygen deprivation in upper body [72]. A Goretex™ graft can be applied to the side of the subclavian artery and then this chimney graft is cannulated. Single circuit chimney graft VA configuration is used for bridging to heart/lung transplantation as it provides easy mobilization [76]. In the illustration the ECMO circuits are simplified. ELSO configuration abbreviation: Vfr-Afldt\Vjr-Asr.