ECMO Indications and Cannulation Strategies - PerfWeb 110 Day 2 | February 25, 2026

PerfWeb 110 – Day 2 examines clinical indications for extracorporeal membrane oxygenation (ECMO) and available cannulation options, focusing on evidence-based criteria for initiation in adult patients with refractory cardiac or respiratory failure. This session addresses decision-making in high-acuity scenarios where standard therapies fail, providing perfusionists with tools to assess suitability and select appropriate access strategies. By clarifying when ECMO offers benefit versus risk, the content supports safer implementation in programs managing acute decompensations.
Learning Objectives

Identify key clinical conditions, such as severe ARDS or cardiogenic shock, where ECMO provides effective temporary support.
Differentiate between venoarterial (VA) and venovenous (VV) ECMO configurations based on underlying pathophysiology.
Evaluate patient-specific factors influencing ECMO candidacy, including contraindications and prognostic indicators.
Describe common cannulation sites and techniques, including peripheral versus central approaches.
Apply strategies to mitigate cannulation-related complications like limb ischemia or recirculation.
Interpret hemodynamic and gas exchange parameters to guide initial ECMO setup and adjustments.

Content Overview
Joe Basha begins with an overview of conditions appropriate for ECMO, drawing on established guidelines from organizations like the Extracorporeal Life Support Organization (ELSO). He reviews scenarios including massive pulmonary embolism, post-cardiotomy shock, and viral pneumonia, emphasizing thresholds for initiation when mechanical ventilation or inotropes prove insufficient.
The discussion then shifts to patient selection, covering scoring systems like the RESP score for VV-ECMO and SAVE score for VA-ECMO. Basha highlights reversible etiologies where ECMO serves as a bridge to recovery or definitive therapy, while noting absolute contraindications such as advanced malignancy or irreversible brain injury.
A detailed segment explores cannulation options, comparing femoral, jugular, and axillary sites for peripheral access, alongside central cannulation via sternotomy. Practical considerations include ultrasound guidance, wire techniques, and dual-lumen cannula placement for VV support.
The session concludes with troubleshooting common issues, such as differential oxygenation in VA-ECMO or flow limitations in VV configurations, offering protocols for repositioning and adjunctive measures like distal perfusion catheters.
Key Topics and Highlights

ARDS refractory to prone positioning and recruitment maneuvers
Cardiogenic shock unresponsive to intra-aortic balloon pump
Bridge to transplant or ventricular assist device in end-stage heart failure
Massive pulmonary embolism with right ventricular failure
Post-cardiotomy inability to wean from cardiopulmonary bypass
VV-ECMO for hypercapnic respiratory failure
VA-ECMO for biventricular support in acute myocardial infarction
Dual-lumen jugular cannula for ambulatory VV-ECMO
Femoral-axillary hybrid configurations to reduce Harlequin syndrome
Ultrasound-guided percutaneous cannulation techniques
Distal limb perfusion to prevent ischemia
Recirculation detection and mitigation in VV setups
Anticoagulation protocols during cannulation
Emergency bedside cannulation in eCPR scenarios
Decannulation strategies and vessel repair

PerfWeb 110 – Day 2 delivers focused guidance on ECMO indications and cannulation, rooted in clinical experience and standard protocols. Perfusionists gain practical frameworks to evaluate patients and execute access strategies, directly impacting deployment efficiency. This content reinforces evidence-aware practice, equipping teams to handle complex cases with reduced morbidity.
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