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Case Reports
. 2013 Nov;16(4):193-197.
doi: 10.1002/j.2205-0140.2013.tb00247.x. Epub 2015 Dec 31.

Malposition of Double Lumen Bicaval Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) cannula resulting in hepatic venous congestion

Konstantin Yastrebov  1 , Tejo Kapalli  1
Affiliations
Case Reports

Malposition of Double Lumen Bicaval Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) cannula resulting in hepatic venous congestion

Konstantin Yastrebov et al. Australas J Ultrasound Med. 2013 Nov.

Abstract

Introduction: Optimal positioning of double lumen bicaval canula for extracorporeal membrane oxygenation (ECMO) support used as a rescue measure in refractory hypoxaemia is essential to facilitate adequate oxygenation, prevent recirculation and avoid complications. Method: Echocardiography via transoesophageal or transthoracic windows can be used as guidance and as a surveillance technique to prevent cannula malposition. We describe a case of Double-Lumen Bicaval VV ECMO cannula malposition leading to a massive retrograde hepatic venous flow. Conclusion: Rapid echocardiographic diagnosis was pivotal in preventing potentially fatal complications.

Keywords: hepatic congestion; transthoracic echocardiography (TTE); venovenous extracorporeal membrane oxygenation.

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Figures

Figure 1
Figure 1
Avalon double lumen bicaval venovenous ECMO cannula.
Figure 2
Figure 2
TTE: Subcostal window. Long‐axis IVC plane. Color Doppler Mode. Normal antegrade flow in the hepatic vein and adequate right atrial return flow from VV ECMO cannula.
Figure 3
Figure 3
TTE: Subcostal window. Continuous Wave Doppler interrogation of blood flow from the return port of VV ECMO cannula inadvertly positioned in IVC.
Figure 4
Figure 4
TTE: Subcostal window. Long‐axis IVC plane: Color Doppler Mode. Massive continuous retrograde flow is demonstrated into hepatic veins from the return port of VV ECMO Cannula.
Figure 5
Figure 5
TTE Subcostal window. Long‐axis IVC plane. Color Doppler interrogation of jet from the return port of VV ECMO cannula adequately positioned within right atrium and directed towards tricuspid valve post‐repositioning of the cannula.
Figure 6
Figure 6
TTE. Subcostal window. Long‐axis IVC plane. Normal antegrade hepatic venous flow is demonstrated with Color Doppler after repositioning of ECMO cannula
See this image and copyright information in PMC

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