Wire puncture technique for placement of perfusion sheath during venous-arterial extracorporeal membrane oxygenation.
Akash Patel, Khiet Hoang, Amir Abolhoda et al.
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Case in brief
A critically ill patient with acute myocardial infarction required VA ECMO during cardiopulmonary resuscitation. Because the large-bore arterial cannula can compromise lower-limb perfusion, an antegrade perfusion sheath was needed. The authors describe placing a 0.035-inch wire from the contralateral femoral artery into the ipsilateral superficial femoral artery to provide an anatomic landmark for puncture and sheath placement. They present this as a simple, reliable approach when placement is challenging, including with an existing arterial cannula or suboptimal ultrasound imaging.
What made this case unusual
The wire is advanced from the contralateral femoral artery into the ipsilateral superficial femoral artery, creating a landmark to guide puncture for the antegrade sheath during VA ECMO.
Diagnostic / clinical pearl
When an antegrade perfusion sheath is difficult to place during VA ECMO, a wire positioned in the ipsilateral superficial femoral artery from the contralateral femoral artery can serve as a puncture landmark.
Why it matters
The described approach offers a less invasive alternative to surgical cutdown in a critically ill, anticoagulated patient.