Table 2. ECMO cannulation strategies.

ECMO configuration	Comments
Veno-venous
Femoro-femoral	Easier cannulation, non-ambulatory, need to have faster organ availability
IJ-femoral	Easier cannulation Less rehabilitation potential, May work
Right IJ double lumen cannula (DLC)	Ambulatory ECMO/Rehabilitation potential, More difficult cannulation technique
DLC with atrial septostomy	May be able to support patients with significant pulmonary hypertension, technically challenging
Directional double lumen catheter (Protek DuoTM)	Support patients with significant pulmonary hypertension, technically challenging, risk of damaging pulmonary artery, higher ECMO flows not achievable (3.5–4 L)
Veno-arterial
Femoral artery-femoral vein	Easy procedure, Non-ambulatory, differential hypoxemia, LV overload, risk lower limb ischemia
Femoral artery- Internal Jugular (IJ) vein	Easy procedure, Non-ambulatory, differential hypoxemia, LV overload, risk for lower limb ischemia
Subclavian/axillary artery-IJ vein	Potential for ambulation, risk for upper extremity ischemia, technically challenging
Central VA	Potential sternotomy required, potential for RV bypass to decompress right heart, surgical site infections, scarring of sternotomy site if prolonged support, Ambulation potential
PA-LA
RA-Aorta
Systemic veins-inominate artery

PA, pulmonary artery; LA, left atrium; LV, left ventricle; RA, right atrium.