Unintended Consequences of the Pandemic: Rapid Development of an Intensivist led Venovenous-Extracorpeal Membrane Oxygenation Cannulation Program

Objective: Veno-venous extracorporeal membrane oxygenation (ECMO) provides support for patients with severe acute respiratory failure Previous literature shows safety of an medical intensivist-led cannulation in a structured program Due to the COVID-19 pandemic, this implementation model required rapid acceleration due to risk of healthcare worker infection and limited resources The objective of this study is to review the safety of a rapidly deployed intensivist-led cannulation program Design: A retrospective review of 15 subjects undergoing percutaneous cannulation for veno-venous extracorporeal membrane oxygenation Setting: Adult ICU at a tertiary academic medical institution Patients: Critically ill adult subjects with severe respiratory failure undergoing percutaneous cannulation for veno-venous extracorporeal membrane oxygenation Interventions: Percutaneous extracorporeal membrane oxygenation Measurements and Results: Subject demographics, support type, cannulation configuration, imaging modalities, and complications were recorded Thirty attempted cannulations with cannula sizes from 18-31F were performed by seven intensivists in 15 subjects All were venovenous ECMO including femoral-femoral (6 6%), IJ-femoral (80%), and dual lumen (13 3%) configuration Pre-insertion and intra-procedural vascular ultrasound was performed in all subjects Fluoroscopy was not used in any patients Transesophageal echocardiography was utilized in 4/15 (26 6%) patients Success rate for cannulation attempts was 93 3% (28/30) No major complications occurred One of the 30 cannulations required surgical assistance Fourteen cannulations were done in 9 weeks 64 2% (9/14) patients survived to hospital discharge with one patient currently on VV ECMO support Conclusions: Percutaneous cannulation for veno-venous ECMO by medical intensivists can be rapidly implemented and performed with a high rate of success and low rate of complications