Extracorporeal membrane oxygenation with right axillary artery perfusion.

Extracorporeal membrane oxygenation can be instituted through various cannulation sites. This paper describes a technique for axillary artery cannulation for inflow perfusion in extracorporeal membrane oxygenation and discusses both potential advantages and limitations. Exposure of the artery was achieved through the deltoid-pectoral approach. Both direct cannulation and interposition graft cannulation are possible, but the latter is preferred. Advantages of axillary artery cannulation are related mainly to the establishment of "central" support with antegrade flow and excellent upper body oxygenation. It also affords chest closure after postcardiotomy shock, and easy control of any mediastinal bleeding. These cannulation sites may be options for the institution of venoarterial extracorporeal membrane oxygenation, especially in postcardiotomy and respiratory failure patients and in patients with significant peripheral vascular disease.