Bedside Emergency Percutaneous Extracorporeal Membrane Oxygenator with Bicaval Dual-Lumen Cannula
DOI:
https://doi.org/10.1532/hsf.1927Keywords:
Venovenous ECMO, bicaval dual-lumen cannula, intensive care, pneumonia.Abstract
Background: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) support has emerged as a valuable rescue therapy in patients with severe acute lung failure. A new bicaval dual-lumen percutaneous cannula can be instituted with a single puncture of the right internal jugular vein under image guidance (fluoroscopy and/or trans-esophageal echocardiography) to support VV-ECMO. However, malpositioning of the dual-lumen catheter can jeopardize the efficacy of the ECMO therapy.
Case report: We report an emergency VV-ECMO instituted at a patient’s bedside in the intensive care unit. Percutaneous insertion of a dual lumen-cannula was performed on a young patient that had undergone cardiac surgery. The patient had developed a fulminant post-operative pneumonia, leading to respiratory failure and septic shock. The procedure was done at night, without any image guidance other than a post-insertion chest x-ray. We compared the oxygen saturation of arterial blood gas taken from both the outflow and inflow ECMO ends, and the saturations were used as indirect proof of correct cannula placement. The VV-ECMO was successfully removed after nine days, as the patient was clinically and radiologically recovered.
Conclusion: This case reports a dual-lumen cannula insertion in an emergency setting, with minimal image support. It confirms the efficacy and the safety of VV-ECMO in the treatment of post-operative acute respiratory failure.
References
Banfi C, Pozzi M, Siegenthaler N, et al. 2016. Veno-venous extracorporeal membrane oxygenation: cannulation techniques. J Thorac Dis 8:3762-73.
Bermudez CA, Rocha RV, Sappington PL, et al. 2010. Initial experience with single cannulation for venovenous extracorporeal oxygenation in adults. Ann Thorac Surg 90:991-5.
Hirose H, Yamane K, Marhefka G, et al. 2012. Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation. J Cardiothorac Surg 7:36.
Javidfar J, Wang D, Zwischenberger JB, et al. 2011. Insertion of bicaval dual lumen extracorporeal membrane oxygenation catheter with image guidance. ASAIO J 57:203-5.
Kuhl T, Michels G, Pfister R, et al. 2015. Comparison of the avalon dual-lumen cannula with conventional cannulation technique for venovenous extracorporeal membrane oxygenation. Thorac Cardiovasc Surg 63:653-62.
Marhong JD, Telesnicki T, Munshi L, et al. 2014. Mechanical ventilation during extracorporeal membrane oxygenation. An international survey. Ann Am Thorac Soc 11:956-61.
Tanaka D, Pitcher HT, Cavarocchi N, et al. 2015. Migrated avalon veno-venous extracorporeal membrane oxygenation cannula: how to adjust without interruption of flow. J Card Surg 30:865-8.
Van Heijst AF, van der Staak FH, de Haan AF, et al. 2001. Recirculation in double lumen catheter veno-venous extracorporeal membrane oxygenation measured by an ultrasound dilution technique. ASAIO J 47:372-6.
Wang D, Zhou X, Liu X, et al. 2008. Wang-Zwische double lumen cannula-toward a percutaneous and ambulatory paracorporeal artificial lung. ASAIO J 54:606-11.
