Five Benefits and Five Drawbacks of Peripheral Cannulation
Peripheral cannulation is a commonly used access method in ECMO (Extracorporeal Membrane Oxygenation) therapy, providing essential life support in severe respiratory and cardiac failure cases. Like central cannulation, peripheral cannulation comes with its own set of advantages and challenges. In my previous article titled “Here Are Three Benefits of High Flow, Central ECMO,” published on July 12, 2024, I focused on the benefits of central cannulation, particularly for high-flow cases. However, peripheral cannulation is often the first choice in many clinical settings, and it’s important to understand both the benefits and limitations of this approach.
Below are five benefits and five drawbacks of peripheral cannulation, based on insights from the ELSO Red Book and the ELSO Training Manual.
Five Benefits of Peripheral Cannulation
Rapid Access in Emergencies One of the main advantages of peripheral cannulation is the speed with which it can be performed, especially in emergencies. Unlike central cannulation, which often requires the resources of an operating room, peripheral access can be quickly established at the bedside in the ICU or even in emergency department settings. This is particularly useful when time is of the essence.
Avoids Sternotomy Peripheral cannulation does not necessitate a sternotomy (opening the chest), making it a far less invasive option. This reduces the surgical risks and recovery time for patients who are critically ill and may not tolerate more invasive procedures well.
Facilitates ECPR (Extracorporeal Cardiopulmonary Resuscitation). In situations requiring ECPR, peripheral cannulation allows for rapid deployment of ECMO while minimizing interruptions to ongoing chest compressions. This provides life-saving support while maintaining resuscitation efforts.
Lower Risk of Mediastinitis Since peripheral cannulation does not involve accessing the mediastinum, it reduces the risk of mediastinitis (a severe infection in the chest cavity). This makes it a safer option regarding postoperative infection risk, especially for patients already vulnerable to infections.
Flexibility in Procedure Location Unlike central cannulation, which often requires an operating room, peripheral cannulation can be performed in more varied settings, such as intensive care units or emergency departments. This flexibility allows critical interventions to happen quickly and without needing OR availability.
Five Drawbacks of Peripheral Cannulation
Limited Flow Rates The cannulas used in peripheral access are generally smaller and longer than those used in central access, resulting in higher resistance and limiting the achievable flow rates. This can be a significant limitation in cases where high flow is essential for maintaining adequate oxygenation and perfusion.
Risk of Limb Ischemia Femoral artery cannulation, a common site for peripheral access, carries a risk of limb ischemia. This occurs when blood flow to the lower extremity is compromised, potentially leading to tissue damage. In some cases, additional procedures such as antegrade limb perfusion or even fasciotomy may be required to restore circulation.
Increased Vascular Complications Cannulating smaller peripheral vessels increases the risk of complications, such as vessel perforation, hematomas, or embolism. These issues can complicate the ECMO procedure and result in longer recovery times and increased risks for the patient.
Differential Hypoxemia, One of the notable complications of venoarterial (VA) ECMO using peripheral cannulation (e.g., femoral access), is the risk of differential hypoxemia. In this scenario, oxygenated blood perfuses the lower body while the upper body, including critical organs like the brain and heart, may receive insufficient oxygenation, potentially leading to dangerous consequences.
Delayed Mobilization Peripheral cannulation, especially when the femoral vessels are used, can limit a patient’s ability to mobilize. Prolonged immobility impacts muscle strength and recovery and increases the risk of complications such as venous stasis and deep vein thrombosis (DVT). These secondary effects can significantly affect a patient’s long-term outcome. ELSO considers jugular or axillary cannulation to provide more flexibility for mobilization but does not discourage mobilization with femoral cannulization, just noting more challenges.
To Sum it up:
Peripheral cannulation in ECMO offers several distinct advantages, such as quicker access and fewer surgical risks, but it’s not without its challenges. The decision to use peripheral versus central cannulation should be based on the clinical needs of the patient and the overall context of care. Understanding the benefits and limitations, as outlined in resources like the ELSO Red Book and the ELSO Training Manual, can help clinicians make the best decisions for their patients. As we’ve discussed previously in my article on the benefits of central cannulation, each method has its place, and balancing the risks with the advantages is crucial to optimizing patient outcomes.
Can you think of any other benefits or drawbacks? Please don’t hesitate to leave a comment.
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Note: This article reflects my learning journey in ECMO and is intended for educational purposes only. It should not be used as a substitute for professional medical advice or guidance. Always consult with qualified healthcare professionals for clinical decisions and patient care.
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I developed three custom GPTs,