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Apr 15, 2026, 16:55
Chokri Ben Lamine: VA-ECMO vs VV-ECMO Thromboembolic Events – Key Clinical Pearls
Chokri Ben Lamine, Adult Hematology and SCT Assistant Consultant at Oncology Center of Excellence at King Faisal Specialist Hospital and Research Center, shared a post on X:
“VA-ECMO vs VV-ECMO Thromboembolic Events – Key Clinical Pearls
Credits: Dr Hazzaa Alzahrani – KFSHRC
VA-ECMO equals Cardiac plus Respiratory support – higher overall thrombotic risk
VV-ECMO equals Respiratory only – high risk but mainly venous/circuit-related
Risk profile
- VA-ECMO – high arterial plus venous thrombosis (shock, low flow, arterial cannulation)
- VV-ECMO – predominantly venous plus circuit thrombosis (less arterial)
Thrombotic pattern
- VA – arterial embolism, stroke, limb ischemia, intracardiac thrombus
- VV – oxygenator clot, circuit thrombosis, cannula-related DVT, VTE
Incidence
- VA – ~17% thrombotic complications (meta-analysis)
- VV – up to ~40% reported (mostly circuit-related)
Limb ischemia
- VA – COMMON (10–30%) due to arterial cannulation major complication
- VV – RARE (no arterial access)
Stroke / systemic embolism
- VA – HIGH risk – thrombus forms in heart/aorta – embolizes systemically
- VV – LOWER – mainly venous events, less arterial embolism
Intracardiac thrombosis
- VA – typical (LV stasis, poor ejection, inadequate unloading)
- VV – NOT typical
Cannula-associated DVT (post-decannulation)
- VV – COMMON, often underdiagnosed
- VA – occurs but less emphasized
Why different?
- VA – shock, low pulsatility, arterial cannulation, LV stasis, endothelial injury
- VV – large venous cannulas, long runs, inflammation, hemolysis, circuit shear stress
Clinical takeaway
- VA-ECMO equals arterial plus embolic complications dominate – stroke and limb ischemia vigilance
- VV-ECMO equals venous/circuit thrombosis dominate – DVT and oxygenator monitoring”
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