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Supraclavicular Approach to the Subclavian Vein as an Alternative Venous Access Site for ECMO Cannulae? A Retrospective Comparison

Bojic, Andja*; Steiner, Irene; Gamper, Jutta; Schellongowski, Peter*; Lamm, Wolfgang*; Hermann, Alexander*; Riss, Katharina*; Robak, Oliver*; Staudinger, Thomas*

doi: 10.1097/MAT.0000000000000529

Venous reperfusion and double-lumen cannulae for extracorporeal membrane oxygenation (ECMO) are usually inserted via the right internal jugular vein. The supraclavicular approach to the right or left subclavian vein could serve as a possible alternative. The aim of this analysis was to compare feasibility, complications, and performance of supraclavicular and jugular cannulation. We retrospectively analyzed charts and registry data of patients undergoing venovenous ECMO. Twenty-four patients underwent jugular cannulation, and 11 patients underwent supraclavicular cannulation. Ten patients underwent femoro-jugular, and five patients underwent femoro-supraclavicular ECMO. Double-lumen cannulae were inserted via the jugular approach in 14 patients and via the supraclavicular approach in 6 patients. No cannulation-associated complications but for a single minor bleeding from the insertion site of a supraclavicular double-lumen cannula were recorded. Performance of the extracorporeal circuit was comparable between jugular and supraclavicular groups but for a more pronounced oxygenation effect in the supraclavicular double-lumen group caused by higher blood flows via larger (24 F) cannulae. The supraclavicular approach seems safe and equivalent to jugular cannulation and could serve as a valid alternative.

From the *Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria; and Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.

ECMO, extracorporeal membrane oxygenation.

Submitted for consideration May 2016; accepted for publication in revised form January 2017.

Disclosure: Two of the authors (Thomas Staudinger, Peter Schellongowski) received speaker fees from Novalung (Xenios) and Maquet.

Correspondence: Thomas Staudinger, Department of Medicine I, General Hospital of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria. Email:

Copyright © 2017 by the American Society for Artificial Internal Organs