Introduction
Historically, extracorporeal membrane oxygenation (ECMO) as a bridge to
heart transplantation was utilized in less than 1% of transplant
recipients and had a one-year survival of 70%1.
Beginning in October 2018, the new heart allocation system significantly
increased the usage of ECMO among heart transplant recipients from 1.6
to
6.5%1.
This represents a critically ill cohort that is temporized on ECMO to
either help recover from cardiogenic shock or to allow completion of
transplant workup and final decision about transplant candidacy. This
cohort requires a delicate balance between continued hemodynamic support
on ECMO while minimizing the adverse effects and physical deconditioning
from immobility2.
Two case reports discuss cannulation techniques that permit ambulation
while on veno-arterial ECMO3,4.
One report utilized the axillary artery and the other used a sternotomy
and limited thoracotomy to achieve central cannulation. In our report,
we present a minimally invasive approach to central cannulation that
does not violate the pericardial space and allows for uninhabited planes
at the time of subsequent heart transplantation.