Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation

Abstract

Placement of the Avalon Elite bicaval dual lumen cannula for venovenous extracorporeal membrane oxygenation (VV-ECMO) via the internal jugular vein requires precise positioning of the cannula tip in the inferior vena cava with echocardiography or fluoroscopy guidance. Correct guidewire placement is clearly the key first step in assuring proper advancement of the cannula. We report a case of unexpected wire migration into the right ventricle at the time of final cannula advancement, resulting in right ventricular rupture and tamponade. Transesophageal echocardiography is an important monitoring modality for appropriate placement of the VV-ECMO guidewire and Avalon cannula, and in particular, for early identification of potential complications.

Bridging to lung transplantation with extracorporeal circulatory support: when or when not?

“…The disadvantage is that peripheral oxygenation is not always predictable and highly depends on the degree of pulmonary vascular resistance. Also, vascular complications such as IVC or right ventricular perforation can be catastrophic (11). It is best to have a practitioner with experience performing this technique under fluoroscopy.…”

Migrated Avalon Veno-Venous Extracorporeal Membrane Oxygenation Cannula: How to Adjust Without Interruption of Flow

“…Early on, we experienced one incidence of cannula malposition into the right ventricle, which required surgical exploration. 8 Now with our routine use of fluoroscopy for cannulation, we have not experienced 12 any additional incidences of malposition of the cannula. However, there have been 5 incidences of cannula migrations, which required reposition of the cannula under either fluoroscopy or ultrasound.…”

Veno-venous extracorporeal membrane oxygenation: cannulation techniques

“…During the repeated dilatation of the skin and subcutaneous tissue and while threading the cannula over the guidewire, the visualization of the guidewire allows the identification of any secondary migration (33). Attention should also be paid to monitoring any new or expanding pericardial collection (34). Occasionally, the existence of an outsized Eustachian valve at the caval-atrial junction induces a translation of the wire into the right ventricle instead of the IVC.…”