Perforation of the Superior Vena Cava During ECMO Catheterization in Two Neonates With Congenital Diaphragmatic Hernia

Bare, Jessica B.; Abramowsky, Carlos R.; Denton, Tiffany D.; Dykes, Francine D.; Shehata, Bahig M.

doi:10.1097/paf.0b013e3181834589

Cited by 7 publications

(3 citation statements)

References 7 publications

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“…[8,9] Common cardiovascular perforations due to ECMO cannulation include cardiac tamponade [10] and superior vena cava perforation, [11] with a high incidence in neonates and children. [6,12] However, IVC perforation in adults and its specific treatment are rarely documented. [13] In the present case, vascular perforation occurred during cannulation and was an iatrogenic complication.…”

Section: Discussionmentioning

confidence: 99%

Emergency and successful management for a case of inferior vena cava perforation caused by cannulation of venovenous extracorporeal membrane oxygenation: A case report

Cen,

Chen,

Chen

2023

Medicine

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Rationale: Vascular complications associated with extracorporeal membrane oxygenation (ECMO) increase the in-hospital mortality. Perforation of the inferior vena cava (IVC) during venovenous extracorporeal membrane oxygenation (V-V ECMO) cannulation and subsequent emergency management prior to vascular surgery has rarely been reported. Patient concerns: A 72-year-old female was diagnosed with IVC perforation caused by venovenous extracorporeal membrane oxygenation cannulation. Diagnoses: Abdominal computed tomography venography with 3D reconstruction confirmed that the cannula tip had perforated the abdominal cavity from the conjunction of the iliac vein and IVC. As a result, the patient was diagnosed with inferior vena cava perforation. Interventions: Attempts to reposition the dislocated cannula using digital subtraction angiography were unsuccessful. However, we found that ECMO could maintain a stable blood flow; therefore, we decided to keep ECMO running, and to minimize blood loss from the puncture site, we ensured adequate blood transfusion while operating V-V ECMO. Subsequently, emergency laparotomy was performed to fix the vascular lesion, and we established a new V-V ECMO circuit through cannulation of the bilateral internal jugular veins. Outcomes: In the case of confirmed V-V ECMO-related vascular perforation of the IVC, it is crucial to continue ECMO device operation to maintain negative pressure in the IVC and position the dislocated catheter to block the perforation site, effectively controlling bleeding. Therefore, emergency laparotomy should be promptly performed for vascular repair. Fortunately, the patient recovered successfully and was subsequently discharged. Lessons: This case highlights several important lessons: When advancing a cannula, in this case, it is essential to first identify the guidewire placement to ensure proper guidance; In the event of a confirmed V-V ECMO-related vascular perforation of the IVC, maintaining negative pressure in the IVC through continued ECMO device operation and positioning the dislocated catheter to block the perforation site are crucial steps to control bleeding prior to emergency open vascular repair; After undergoing vascular repair, if ECMO support is still necessary, it is advisable to opt for a catheterization strategy that avoids previously repaired blood vessels.

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Section: Discussionmentioning

confidence: 99%

Emergency and successful management for a case of inferior vena cava perforation caused by cannulation of venovenous extracorporeal membrane oxygenation: A case report

Cen,

Chen,

Chen

2023

Medicine

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“…Moreover, cannulation under echocardiographic guidance may prevent other kinds of complications, for instance, blood vessel perforation. In CDH, perforation of the SVC has been described as a possible complication due to the mediastinal shift that occurs in this situation, which exposes the SVC to a higher risk of trauma (21).…”

Section: Discussionmentioning

confidence: 99%

Successful Extracorporeal Membrane Oxygenation After Incidental Azygos Vein Cannulation in a Neonate With Right-Sided Congenital Diaphragmatic Hernia Interruption of the Inferior Vena Cava and Azygos Continuation

et al. 2019

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Incidental azygos vein cannulation has been reported in a few cases of neonatal extracorporeal membrane oxygenation (ECMO). This complication is described in the literature mainly in pathological conditions wherein increased central venous pressure dilates the superior vena cava (SVC), i.e., right congenital diaphragmatic hernia (CDH) or pulmonary hypertension. Azygos vein cannulation should always be suspected in cases of impaired venous return and circuit failure. Although rare, it hinders proper venous aspiration of the ECMO circuit and generally requires repositioning or replacement of the venous cannula or conversion to central cannulation. In this report, we describe a newborn with severe right CDH who required ECMO assistance, wherein incidental cannulation of the azygos vein resulted in successful functioning of the circuit because of the concomitant presence of isolated interruption of the inferior vena cava and azygos continuation. To the best of our knowledge, this is the first report of successful neonatal ECMO despite azygos vein cannulation in a patient with such rare physiology.

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“…Mediastinal shift can distort the venous anatomy of the neck and upper mediastinum and it may not be possible to pass a transcervical venous cannula safely into the right atrium. Superior vena caval perforation following attempted cervical venous cannula placement has been reported . Sternotomy should be considered if there is any difficulty with transcervical cannulation.…”

Section: Discussionmentioning

confidence: 99%

Repair of congenital diaphragmatic hernia during extracorporeal life support: experience with six neonates

Prabhu

Mattke

Anderson

et al. 2016

ANZ Journal of Surgery

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Data from our small cohort of patients illustrate that early survival is possible in extremely compromised neonates who otherwise would have died without ECLS. Our experience demonstrates that CDH repair can safely be performed during ECLS. Use of ECLS, early repair during ECLS, lung protective ventilation strategies and aggressive management of pulmonary hypertension were associated with good early survival. ECLS should be considered as an integral part of therapeutic armamentarium for CDH in neonates.

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Perforation of the Superior Vena Cava During ECMO Catheterization in Two Neonates With Congenital Diaphragmatic Hernia

Cited by 7 publications

References 7 publications

Emergency and successful management for a case of inferior vena cava perforation caused by cannulation of venovenous extracorporeal membrane oxygenation: A case report

Emergency and successful management for a case of inferior vena cava perforation caused by cannulation of venovenous extracorporeal membrane oxygenation: A case report

Successful Extracorporeal Membrane Oxygenation After Incidental Azygos Vein Cannulation in a Neonate With Right-Sided Congenital Diaphragmatic Hernia Interruption of the Inferior Vena Cava and Azygos Continuation

Repair of congenital diaphragmatic hernia during extracorporeal life support: experience with six neonates

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