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Recirculation in VV-ECMO

Recirculation is a condition which may occur in venovenous ECMO configuration: in relation to this phenomenon, a variable fraction of the reinfused oxygenated and decarboxylated blood is withdrawn through the drainage cannula. Recirculated blood bypasses systemic circulation without supporting CaO2, so recirculation fraction does not contribute to DO2, lessening the efficacy and the efficiency of extracorporeal respiratory support.


In this video recirculation in femoro-femoral cannulation and in femoral drainage/jugular reinfusion cannula configuration, respectively.

All details about diagnosis, significance & management of recirculation in the ELSO specific open access guideline: Identification and management of recirculation in venovenous ECMO 


Abrams D, Bacchetta M, Brodie D. Recirculation in venovenous extracorporeal membrane oxygenation. ASAIO J. 2015 Mar-Apr;61(2):115-21. open access 
Rich PB, Awad SS, Crotti S, Hirschl RB, Bartlett RH, Schreiner RJ. A prospective comparison of atrio-femoral and femoro-atrial flow in adult venovenous extracorporeal life support. J Thorac Cardiovasc Surg. 1998 Oct;116(4):628-32. open access 
Palmér O, Palmér K, Hultman J, Broman M. Cannula Design and Recirculation During Venovenous Extracorporeal Membrane Oxygenation. ASAIO J. 2016 Nov; 62(6): 737–742. open access 
Körver EPJ, Yuri M. Ganushchak YM, Simons AP, Donker DW, Maessen JG, Weerwind PW. Quantification of recirculation as an adjuvant to transthoracic echocardiography for optimization of dual-lumen extracorporeal life support. Intensive Care Med. 2012 May; 38(5): 906–909. open access 

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