Fig. 5

Various forms of V-V ECMO configurations and their characteristics. Various forms of V-V ECMO configurations can be used, according to their merits and demerits. a Femo-jugular approach: It is probably the most widely used configuration and has the advantage of being generalized and easy to use. However, since the neck and inguinal area are fixed, the physical liberality is low. In addition, recirculation is obvious. b Femo-femoral approach: Both two cannulas are placed in the vena cava inferior or the right atrium, approached from the left and right inguinal areas. Adequate diameter of vena cava inferior is essential. Side holes of return cannula must be centralized at the tip. c Double lumen cannula: It is usually approached through the right jugular vein, passing through the right atrium and locating the tip in the vena cava inferior. It has the advantage of complete freedom of both lower limbs. However, it is also associated with the disadvantages including the risk of malpuncture of the heart, inadequate positioning of the side hole of the return cannula not facing to the tricuspid valve, and the limited ECMO blood flow. RA, right atrium; RV, right ventricle; Ao, aorta; DC, drainage cannula; RC, return cannula