Torre Debora Emanuela, Pirri Carmelo
Department of Cardiac Anesthesia and Intensive Care Unit, Cardiac Surgery, Ospedale dell'Angelo, 30174 Venice Mestre, Italy.
Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy.
J Clin Med. 2025 Aug 1;14(15):5413. doi: 10.3390/jcm14155413.
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used to support patients with refractory cardiogenic shock or cardiac arrest. While femoral artery cannulation remains the most common arterial access, axillary artery cannulation has emerged as a valuable alternative in selected cases. : This narrative review aims to synthesize current evidence and expert opinion on axillary artery cannulation in V-A ECMO, focusing on its technical feasibility, physiologic implications, and clinical outcomes. : A comprehensive literature search was performed in PubMed and Scopus using relevant keywords related to ECMO, axillary artery, cannulation techniques, and outcomes. Emphasis was placed on prospective and retrospective clinical studies, expert consensus statements, and technical reports published over the past two decades. : Axillary cannulation provides antegrade aortic flow, potentially reducing the risk of differential hypoxia and improving upper body perfusion. However, the technique presents unique technical challenges and may carry risks such as hyperperfusion syndrome or arterial complications. Emerging data suggest favorable outcomes in selected patient populations when performed in experienced centers. Axillary cannulation represents a promising arterial access route in V-A ECMO, particularly in cases with contraindications to femoral cannulation or when upper-body perfusion is a concern. Further prospective studies are needed to better define patient selection criteria and long-term outcomes.
静脉-动脉体外膜肺氧合（V-A ECMO）越来越多地用于支持难治性心源性休克或心脏骤停患者。虽然股动脉插管仍然是最常见的动脉入路，但在某些特定情况下，腋动脉插管已成为一种有价值的替代方法。本叙述性综述旨在综合当前关于V-A ECMO中腋动脉插管的证据和专家意见，重点关注其技术可行性、生理影响和临床结果。在PubMed和Scopus中使用与ECMO、腋动脉、插管技术和结果相关的关键词进行了全面的文献检索。重点关注过去二十年发表的前瞻性和回顾性临床研究、专家共识声明和技术报告。腋动脉插管可提供主动脉顺行血流，有可能降低差异缺氧风险并改善上身灌注。然而，该技术存在独特的技术挑战，可能会带来诸如高灌注综合征或动脉并发症等风险。新出现的数据表明，在经验丰富的中心对选定患者群体进行腋动脉插管时，可取得良好的结果。腋动脉插管是V-A ECMO中一种有前景的动脉入路，特别是在存在股动脉插管禁忌证或关注上身灌注的情况下。需要进一步的前瞻性研究来更好地确定患者选择标准和长期结果。
