Position paper on the physiology and nomenclature of dual circulation during venoarterial ECMO in adults

Jenelle Badulak, Darryl Abrams, Andrew M. Luks, Bishoy Zakhary, Steven A. Conrad, Robert Bartlett, Graeme MacLaren, Leen Vercaemst, Roberto Lorusso, Lars Mikael Broman, Cara Agerstrand, Susanna Price, Alain Combes, Giles Peek, Eddy Fan, Kiran Shekar, John Fraser and Daniel Brodie on behalf of the Extracorporeal Life Support Organization (ELSO). DOI: 10.1007/s00134-024-07645-8

Abstract: When native blood flow through the aorta from the adult heart and lungs meets retrograde blood flow from an artificial heart and lung during venoarterial extracorporeal membrane oxygenation (VA-ECMO), the result is the creation of two separate circulations on either side of the blood flow mixing point. This phenomenon is known as dual circulation and is characterized by different content of oxygen and carbon dioxide between the circulations. There is currently a lack of clarity surrounding the nomenclature to describe this physiologic phenomenon in VA-ECMO and thus we endeavour to name and define these terms to facilitate clear communication and proper clinical management of these patients.