Peripheral cannulation for cardiopulmonary bypass.

Peripheral cannulation is the historical route for connecting the pump-oxygenator to the vasculature of the patient in order to establish partial or complete cardiopulmonary bypass. Although most open heart procedures are nowadays realized with central cannulation, there is renewed interest in remote cannulation through the femoral, iliac, axillary, subclavian and jugular vessels. Remote cannulation is not only of interest in hemodynamically unstable patients who can be put on cardiopulmonary bypass in local anesthesia, and stabilized prior to intubation, but also for complex procedures like replacement of the thoracoabdominal aorta, acute type A aortic dissections, complex redo open heart surgery, extracorporeal membrane oxygenation, and more recently, small access open heart surgery, robotic surgery, and others. In the following shall be described femoral arterial cannulation with standard cannulas, femoral arterial cannulation with percutaneous cannulas, femoral venous cannulation using standard cannulas, femoral venous cannulation using percutaneous cannulas, as well as optimized venous cannulation relying on more advanced cannula designs.