Double lumen catheter placement during VV ECMO in an infant with persistent left superior vena cava-important considerations.

Abstract

Extracorporeal membrane oxygenation (ECMO) is a salvage therapy in acute cardiac failure and/or severe respiratory failure. In this case report the importance of cannula positioning during veno-venous ECMO is exemplified. The use of echocardiography and its advantages compared to plain chest radiograph will be shown. This case reflects a 5-month-old boy who acquired a severe viral pneumonia leading to respiratory failure and ECMO treatment. Extracorporeal membrane oxygenation was performed via a dual lumen cannula correctly placed in the right atria according to a chest radiograph. During the first day of treatment the patient's arterial saturation was not satisfying. Assessment revealed that a part of the ECMO flow was recirculating. Echocardiography was used to optimize the cannula position, and thus, rapidly improving the patient's oxygenation. A persistent left superior vena cava and its effect on the central hemodynamics were also objectified. This case illustrates important considerations in daily ECMO treatment: the benefit of direct echocardiographic competence at all times during the day, the importance of understanding central blood flow dynamics, to adjust the cannula-position accordingly, and to address situations outside the ordinary with a physiologic approach.

• Authors: L Mikael Broman, Jan Hultman
• Journal: ASAIO journal (American Society for Artificial Internal Organs : 1992) (ASAIO J) 2014 Sep-Oct Vol. 60 Issue 5 Pg. 603-5 ISSN: 1538-943X [Electronic] United States
• PMID: 25010919 (Publication Type: Case Reports, Journal Article)

Topics

• Catheters
• Esophageal Atresia (complications)
• Extracorporeal Membrane Oxygenation (methods)
• Humans
• Infant
• Male
• Pneumonia, Viral (complications)
• Respiratory Insufficiency (therapy, virology)
• Vena Cava, Superior (abnormalities)