Noninvasive Repair of Dual Lumen Cannula Crack in a Patient Supported With Extracorporeal Membrane Oxygenation

Abstract

BackgroundThe use of extended duration extracorporeal membrane oxygenation (ECMO) has significantly increased during the COVID-19 pandemic. However, prolonged ECMO support heightens the risk of severe complications within the circuit, such as fractures of the cannula, complicating clinical management.InterventionA 16-year-old male presented to the emergency department with a Glasgow Coma Score (GCS) of 3 following a rollover motor vehicle accident. Imaging indicated multifocal intracranial hemorrhage and diffuse axonal injury. He was admitted to the intensive care unit, where Neurosurgery placed an intracranial pressure (ICP) monitor and extraventricular drain (EVD). The patient developed hypoxemic respiratory failure due to acute respiratory distress syndrome (ARDS). With parental consent, veno-venous (VV) ECMO support was initiated. Cannulation went smoothly, and ECMO was maintained for nine days with minimal complications. However, on day nine, the cannula site began to ooze for 13 days despite several interventions, including dressing changes and attempts at suture repair. Inspection revealed a crack on the return side of the bicaval cannula, causing the bleeding. To avoid cannula exchange, Dermabond was used to seal the defect.OutcomeFollowing the Dermabond application, the cannula site was hemostatic, and imaging showed stable cannula positioning. The patient remained on ECMO for an additional 49 days, ultimately achieving respiratory recovery and successful decannulation. He was later discharged to an inpatient rehabilitation facility and then home with a good prognosis.ConclusionDermabond application for ECMO circuit repair proves is an effective strategy for minimizing risks related to cannula exchange during circuit dysfunction.

Keywords: acute respiratory distress syndrome; case report; critical care; dermabond; extracorporeal membrane oxygenation.