Bedside Percutaneous ECMO Cannulation without Fluorscopy or Transesophageal Echocardiogram with Right Atrium to Left Atrium Bypass in Patients with COVID-19. RALA, as the Novel Cannulation for ECMO in Patients with ARDS

Background: Adult respiratory distress syndrome (ARDS) is a common complication of COVID-19 infection We hypothesized that ECMO via right to left atrium (RA-LA) cannulation through an oxygenator will lead to a complete lung rest, allowing for complete recovery of the lungs Methods: We performed bedside ICU ECMO procedure in 5 patients (3 males and 2 females) by using intracardiac echocardiography (ICE) via right common femoral vein and standard transseptal technique at bedside Subsequently, we placed a 21F LA cannula (TandemHeart, Tandem-Heart, Pittsburgh, PA) via the right common femoral vein and a 25F RA cannula (Edwards, Irvine, CA) The oxygenerator was also TandemHeart system Results: All 5 patients were safely cannulated and managed by ECMO The duration of ECMO was 13 to 19 days and were successfully decannulated at bedside Only one patient did not require tracheostomy and was discharged home on day 33 The other 4 patients were discharged from the hospital to long-term care acute care facilities No major procedural complications occurred One patient required dialysis (See table) Conclusion: Bedside percutaneous RA-LA cannulation is feasible with no major procedural complications Further studies are required to evaluate short and long-term hard endpoints in all patients with ARDS compared to veno-venous ECMO cannulation