The room must contain an operating light, electrocautery generator, and enough space for the surgeons to move around the patient. In order to facilitate the swiftness of the implantation, the surgeon, before arriving on site, usually asks for the equipment to be prepared and for surgical preparation of the cannulation site (depilation and sterile cleaning) to be carried out.

The patient is positioned supine with a block, usually made of rolled sheets, under the pelvis or the patient’s shoulder in order to improve exposure of the surgical site. The patient must have received an operating room and a toilet depilation of the surgical site. A backup site should always be provided in case of cannulation failure. Usually, for a femoral cannulation, both sides of the groin are prepared. This will also give the advantage of varying cannulation sites (artery and vein from one side to the other to reduce the risk of ischemia). You must then install the electrocautery plate away from any metal prosthesis on healthy and fleshy skin.

This will be followed by a sterile wash according to the unit protocol, which will start from the ear and run to the patient’s knees bilaterally. The right jugular site is exclusively used. If dressings are present in those areas, they must be removed first.

To avoid the risk of an electric arc between the electrocautery and the presence of alcohol vapor, do not use alcohol antiseptic, which could cause severe burns to the patient.

Once the patient is installed and the approach sites prepared, the dressing with surgical gowns can begin. A pack of surgical drapes is positioned at the patient’s foot or on a side table. The positioning of the sterile drapes must meet the standards of sterility. A suction line is sterilely given to the nurse, who connects it to a strong suction connected to a collecting tray.

The nurse/resident installs the instrumentation table with all the necessary tools for the ECMO/ECLS implementation and prepares local anesthesia if necessary. In case of a mechanically ventilated patient, he ensures that sedation and analgesia are appropriate.

During this phase of installation and surgical approach, the perfusionist installs the ECMO/ECLS console in the patient’s room. The console must be connected to a power supply and an air and oxygen wall supply. The entire ECMO/ECLS console must be equipped with an air/oxygen gas mixer, an emergency crank, a centrifugal pump, a membrane support, and two Vorse tube press clips (usually called Weiss clamps) (Fig. 4.2). A heat generator will warm the priming at first, and then regulate the patient’s temperature. After installing the console, the perfusionist will de-air the circuit.