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

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.

Extracorporeal Membrane Oxygenator Rotational Cannula Catastrophe: A Role of Echocardiography in Rescue

“…Cannula malposition was identified early using TTE, and appropriate repositioning of the cannula was undertaken, thus saving the patient from the likelihood of developing a massive degree of retrograde flow into the hepatic veins with the potential to cause severe hepatic venous congestion, hepatic insufficiency, severe portal hypertension, and capsular distention and rupture. 12 Even though TEE may provide superior spatial resolution for the visualization of ECMO cannulae, this case demonstrates that TTE still can play an important role in the management of the patient requiring ECMO support. Because cannula malposition can lead to rapid clinical deterioration with potentially fatal consequences, the use of a noninvasive, focused TTE examination to quickly and easily identify and correct cannula malposition is obvious.…”

Acute Congestive Hepatopathy, Diagnosed With Point-of-Care Hepatic Ultrasound in a Patient on Extracorporeal Membrane Oxygenation

“… 13 Several case reports have described the use of transthoracic echocardiography (TTE) to interrogate a pVV-ECMO cannula creating a congestive hepatopathy, which resulted in the correction of hepatic venous obstruction and retrograde hepatic venous flow. 7 , 8 Hepatic ultrasound evaluation, with portal spectral Doppler interrogation, is vital to the workup of a hepatic injury. Figure 4 illustrates basic hepatic anatomy, while Figure 5 further characterizes this anatomy and depicts probe placement for ultrasound image acquisition.…”

“…A rarely reported complication of ECMO therapy involves hepatic congestion due to aberrant cannula placement. 7 , 8 Herein, we report a case of acute hepatic decompensation in a patient receiving centralized venovenous ECMO (VV-ECMO) therapy and describe the further characterization of this phenomenon through interrogation of hepatic venous spectral Doppler flow rate. The patient’s family provided permission for the publication of this report.…”

Bicaval dual lumen cannula placement using transthoracic echocardiography in COVID-19 scenario: pearls and pitfalls

“…A recent study demonstrated up to 38% of patients requiring echo-guided cannula adjustment after initial successful cannula positioning,14 Avalon cannula dislocation can be classified into longitudinal and rotational. In case of longitudinal dislocation, the cannula tip may be advanced too deeply and cause hepatic congestion, either directly by cannula threading into the hepatic vein, or indirectly by retrograde flow emanating from the middle port 13 15 16. On the contrary, the cannula tip may be too shallow in the right atrium and impacts the surrounding structures, such as right coronary artery compression, coronary sinus insertion or is deviated into the right ventricle and causes tricuspid injuries and even right ventricular perforation 8 11 17.…”