The selection of the mode of support is based on the physiological needs of the patient.

ECMO Configuration refers to the manner in which a particular mode is employed. Any mode of ECMO may be applied to a patient in different ways (different cannula types, different cannula tip positions and different insertion sites) but all share common physiological effects.

See configurations and nomenclature sections. ECMO.icu

Modes of ECMO:

• Veno-venous ECMO (VV ECMO): Blood is accessed from the venous side of the circulation (typically from great veins) and returned to the venous side of the circulation (typically to the right atrium). This mode provides support for respiratory failure by providing non-pulmonary gas exchange. Native cardiac function provides cardiac output and pulmonary blood flow.
• Veno-arterial ECMO (VA ECMO): blood is accessed from the venous side of the circulation (typically the right atrium), bypasses the pulmonary circulation and is returned to the arterial side of the circulation (aorta). This mode provides arterial circulation and organ perfusion despite native cardiac failure. This mode unloads right ventricular failure but does NOT unload left ventricular failure.
• Veno-pulmonary artery ECMO (VPA ECMO): blood is accessed from the venous side of the circulation (typically the right atrium) and returned to the pulmonary artery. This mode provides support for right ventricular failure and non-pulmonary oxygenation. Blood bypasses the right ventricle. Typically it is used to support transient right ventricular failure following insertion of a durable left ventricular assist device (LVAD).

• Hybrid ECMO modes: These modes of physiological support are more complex than the 3 previously described modes, as they employ more than one site of access, or, more than one site of return. Blood may be accessed from more than one part of the circulation and blood may be returned to more than one region and hence provide more than one form of physiological support. An example of hybrid ECMO support is the veno-veno + arterial ECMO. In this hybrid mode, blood is accessed from the venous system and returned to both the venous system AND the arterial system. It provides significant respiratory and cardiac support.

• Short Term Mechanical Cardiac Support Modes: These modes of support are different to ECMO modes because, while they share many features with an ECMO circuit and employ a blood pump, they do not have oxygenators in the circuit. These modes provide blood pumping for failing ventricles by accessing blood before the ventricle and returning it to arteries after the ventricle. Three short-term mechanical cardiac support modes are: right ventricular assist device – RVAD; left ventricular assist device (LVAD) or both (BiVAD).