Catheter-based extracorporeal membrane oxygenation (ECMO)
Apparatuses and methods for performing transseptal extracorporeal membrane oxygenation are disclosed. The method may include puncturing a septum between the right atrium and the left atrium and advancing a catheter system through the puncture and into the aorta. The catheter system may include coaxially arranged and independently moveable venous and arterial sheaths having independently positionable openings for removing blood from the patient and for returning oxygenated blood to the patient, e.g., within the aorta.
1 . A method for performing transseptal extracorporeal membrane oxygenation (ECMO) on a patient, the method comprising:
introducing an arterial sheath catheter through a right atrium and into a patient's heart via an arterial access site;
advancing a daughter inner catheter through the arterial sheath catheter and into a left atrium;
advancing a granddaughter inner catheter out of a lumen of the daughter inner catheter and into the left ventricle with a balloon at a distal end of the granddaughter inner catheter at least partially expanded;
deflecting a distal end region of the granddaughter inner catheter towards an aortic valve;
advancing the granddaughter inner catheter distally across the aortic valve and into an ascending aortic arch;
advancing the daughter inner catheter distally into the ascending aortic arch;
advancing the arterial sheath catheter over the daughter inner catheter until the arterial sheath catheter is at least 1 cm distal to the aortic valve; and
receiving, from the patient, oxygen-poor blood through a venous sheath catheter and returning oxygenated blood through the arterial sheath catheter to the ascending aortic arch.
2 . The method of claim 1 , wherein deflecting the granddaughter inner catheter comprises advancing the daughter inner catheter over the granddaughter inner catheter and deflecting the daughter inner catheter to deflect the granddaughter inner catheter.
3 . The method of claim 1 , wherein advancing the daughter inner catheter comprises advancing the daughter inner catheter distally over the granddaughter inner catheter into the ascending aortic arch.
4 . The method of claim 1 , wherein advancing the arterial sheath catheter over the daughter inner catheter comprises advancing the arterial sheath catheter over the daughter inner catheter and granddaughter inner catheter.
5 . The method of claim 1 , further comprising withdrawing the daughter inner catheter and granddaughter inner catheter through the arterial sheath catheter before returning oxygenated blood through the arterial sheath catheter.
6 . The method of claim 1 , wherein deflecting the distal end region of the granddaughter inner catheter comprises actuating a deflection mechanism comprising a pullwire extending through the daughter inner catheter to deflect the distal end region of the daughter inner catheter.
7 . The method of claim 1 , further comprising delivering a guidewire through the granddaughter inner catheter into the left ventricle before advancing the granddaughter inner catheter.
8 . The method of claim 1 , further comprising delivering a guidewire through the granddaughter inner catheter and into the ascending aorta before advancing the granddaughter inner catheter into the ascending aorta.
9 . The method of claim 1 , further comprising advancing the venous sheath catheter over the mother catheter.
10 . The method of claim 9 , wherein advancing the venous sheath catheter comprises sealing the venous sheath catheter to an outer surface of the arterial sheath catheter.
11 . The method of claim 1 , further comprising positioning the venous sheath catheter in an inferior vena cava.
12 . The method of claim 1 , wherein the granddaughter inner catheter includes a low durometer deflection jacket that allows asymmetric compression of an inner shaft under pull wire tension.
13 . The method of claim 1 , further comprising positioning the venous sheath catheter so that a plurality of inflow openings on the venous sheath catheter are positioned within the right atrium, the left atrium, or both the right atrium and left atrium.
14 . The method of claim 1 , wherein the daughter inner catheter includes a laser-cut hypotube with a spine to control planar deflection.
15 . The method of claim 1 , further comprising visualizing a radiopaque distal tip and a mid-shaft marker band on the granddaughter inner catheter.
16 . The method of claim 1 , further comprising coupling the arterial sheath catheter and the venous sheath catheter to an ECMO pump device and performing ECMO.
17 . A method for performing transseptal extracorporeal membrane oxygenation (ECMO) on a patient, the method comprising:
introducing an arterial sheath catheter through a right atrium and into a patient's heart via an arterial access site;
advancing a daughter inner catheter through the arterial sheath catheter and into a left atrium;
advancing a granddaughter inner catheter out of a lumen of the daughter inner catheter and into the left ventricle with a balloon at a distal end of the granddaughter inner catheter expanded;
advancing the daughter inner catheter over the granddaughter inner catheter;
deflecting a distal end region of the granddaughter inner catheter towards an aortic valve;
advancing the granddaughter inner catheter distally out of the daughter inner catheter across the aortic valve and into the ascending aorta;
advancing the daughter inner catheter distally over the granddaughter inner catheter into the ascending aorta;
advancing the arterial sheath catheter over the daughter inner catheter and granddaughter inner catheter until the arterial sheath catheter is at least 1 cm distal to the aortic valve; and
receiving, from the patient, oxygen-poor blood through a venous sheath catheter and returning oxygenated blood through the arterial sheath catheter to the ascending aortic arch.
18 . The method of claim 17 , further comprising positioning the venous sheath catheter so that a plurality of inflow openings on the venous sheath catheter are positioned within the right atrium, the left atrium, or both the right atrium and left atrium.
19 . The method of claim 17 , further comprising coupling the arterial sheath catheter and the venous sheath catheter to an ECMO pump device and performing ECMO.
20 . A method for performing transseptal extracorporeal membrane oxygenation (ECMO) on a patient, the method comprising:
introducing an arterial sheath catheter through a right atrium and into a patient's heart via an arterial access site;
advancing a daughter inner catheter through the arterial sheath catheter and into a left atrium;
advancing a granddaughter inner catheter out of a lumen of the daughter inner catheter and into the left ventricle with a balloon at a distal end of the granddaughter inner catheter at least partially expanded;
deflecting a distal end region of the granddaughter inner catheter towards an aortic valve;
advancing the granddaughter inner catheter distally across the aortic valve and into an ascending aortic arch;
advancing the daughter inner catheter distally into the ascending aortic arch;
advancing the arterial sheath catheter over the daughter inner catheter until the arterial sheath catheter is at least 1 cm distal to the aortic valve;
positioning a venous sheath catheter so that a plurality of inflow openings on the venous sheath catheter are positioned within the right atrium, the left atrium, or both the right atrium and left atrium; and
receiving, from the patient, oxygen-poor blood through the venous sheath catheter and returning oxygenated blood through the arterial sheath catheter to the ascending aortic arch.