Multistage Jugular Cannulation: A Case Series of Leaving the Femoral Vein Behind in Venoarterial Extracorporeal Membrane Oxygenation

Superior vena cava drainage during venoarterial extracorporeal membrane oxygenation (ECMO) may reduce access insufficiency and differential oxygenation and is typically achieved via the femoral approach. Direct multistage jugular cannulation may be optimal. Despite its use at select centers, this approach is not well discussed in the literature. We present five percutaneous jugulo-femoral venoarterial ECMO initiations from our high-volume, intensivist-led service. Each case offers unique indication for direct SVC drainage in lieu of conventional femoral access. No injuries resulted from jugular cannulation, and ECMO therapy of up to 16 days proceeded in the absence of circuit or patient complications. Four patients survived to hospital discharge, while one was palliatively decannulated.