• Jeffrey E Keenan, Matthew A Schechter, Desiree K Bonadonna, Raquel R Bartz, Carmelo A Milano, Jacob N Schroder, and Mani A Daneshmand.
• From the *Department of Surgery, Division of Cardiothoracic Surgery, †Division of Perfusion Services, and ‡Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
• ASAIO J. 2016 May 1; 62 (3): e30-4.

AbstractAdvances in technology for the delivery of venoarterial extracorporeal membrane oxygenation (VA-ECMO) have allowed for its expanded utilization in the treatment of patients with advanced cardiogenic shock, particularly through the use of peripheral cannulation strategies. However, peripheral VA-ECMO continues to be hampered by several major limitations including inadequate decompression of the left ventricle, lower limb ischemia, and the inability to mobilize patients. Here, we present a case series of three patients who were treated with a hybrid peripheral-central cannulation strategy accompanied by direct decompression of the left ventricle through a right anterior mini-thoracotomy. This novel approach ameliorates several of the current limitations to peripheral VA-ECMO therapy and thereby holds potential for improving outcomes in VA-ECMO patients.

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