Insertion of extracorporeal membrane oxygenation circuit

PROCEDURE PERFORMED: Insertion of extracorporeal membrane oxygenation circuit. ANESTHESIA: General. OPERATIVE INDICATIONS: The patient a 52-year-old African American male who previously had placement of a HeartMate II left ventricular assist device. The device seems to be nonfunctional at this time despite multiple pressor support. He has continued to develop cardiogenic shock and multisystem organ failure. ECMO circuit is indicated to help stabilize him prior to a planned device exchange. OPERATIVE TECHNIQUE: The patient was placed on the OR table in the supine position. General anesthesia was induced. He was prepped and draped in the usual sterile fashion. A small transverse incision was made in the right groin and right femoral artery and vein isolated. A 10-mm Hemashield graft was then sewn end to side to the common femoral artery after administration of intravenous heparin. The Hemashield graft was then tunneled subcutaneously to exit the skin in the upper thigh. A 29-French percutaneous venous cannula was then placed in the femoral vein without difficulty. The cannula was then attached to the ankle circuit and flow initiated. There was excellent flow with excess of 6 liters per minute. Transesophageal echo showed good cannulà placed in the right atrium. There was significant coagulopathic bleeding from the femoral artery which took in excess of 2 hours to control with various hemostatic agents. Eventually, hemostasis was assured and the wound closed in layered closure of Vicryl and subcuticular stitch for skin. The patient was returned to the 1CU in critical condition. SA1522