Use of Bicaval Dual-Lumen Catheter for Adult Venovenous Extracorporeal Membrane Oxygenation

Javidfar, Jeffrey; Brodie, Daniel; Wang, Dongfang; Ibrahimiye, Ali N.; Yang, Jixiang; Zwischenberger, Joseph B.; Sonett, Joshua R.; Bacchetta, Matthew

doi:10.1016/j.athoracsur.2011.03.002

Cited by 156 publications

(134 citation statements)

References 9 publications

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“…(3,4). In our experience, the patient had greater BMI (40.1 Kg/m 2 ) and the VV-ECMO was performed for 21 days and in addition our patient confirmed that the obesity decreases the sensitivity of peripheral tissues to leptin signals and can compromise the immune system as reported in literature.…”

Section: Discussionsupporting

confidence: 86%

“…The distal opening should be placed into the inferior vena cava, while the proximal tip should be in the right atrium facing the tricuspid valve. The correct positioning should be verified through fluoroscopy, transthoracic echocardiogram or TEE which is strong recommended (3,4,5).…”

Section: Discussionmentioning

confidence: 99%

“…The Murray Score (1) was 3.5 and arterial blood gases (ABG) showed: pH 7.33, pO 2 40 mmHg, pCO 2 51 mmHg, HCO3 25 mmol/L, pO 2 /FiO 2 ratio 172 and evidence of mild tissue hypoxia (Lactate 3.4, SVO2 74.7, Table 1). Laboratory values revealed white blood count (WBC) 4.420 x 10 9 /l,C-Reactive Protein (CRP) 8,45 mg/dl, the cultural samples were collected and both the tracheal aspirate and the nasal swab tested were positive to Influenza A (not type H1N1). The patient had no other sign of systemic failure (PA 165/50 mmHg, HR 95 beats/min, diuresis 70 ml/h).…”

Section: Main Body Textmentioning

confidence: 99%

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Single or Double Site Cannuation for Veno-Venous Ecmo in Severe Obese Patient?

2016

ARC Journal of Anesthesiology

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Veno -venous extracorporeal membrane oxygenation (VV-ECMO) is an extracorporeal respiratory support used as therapeutic option in patients affected Abbreviations: VV-ECMO-Veno-venous Extracorporeal Membrane Oxygenation, ARDS-Acute Respiratory Distress Syndrome, BMI-Body Mass Index, CT-Computed Tomography, ABG-Arterial blood gases, WBC-White Blood Count, CRP-C-Reactive Protein, TEE-Transesophageal Echocardiographic, APTT-Activated Partial Thromboplastin Time, SIMV-Synchronized,Intermittent Mandatory Ventilation, PS-Pressure Support, PEEPPositive end-expiratory pressure, RR-Respiratory Rate MAIN BODY TEXTA 49-year-old male affected by severe obesity (BMI 40.1 Kg/m 2 ), sleep apnea syndrome and type II diabetes mellitus, developed severe ARDS by influenza A, which was not responsive to maximal ventilatory support and to cycles of prone positioning in a secondary hospital. After 48 hours, the patient was recovered to our Cardiovascular Intensive Care Unit to perform VV-ECMO treatment.Upon admission, the chest Computed Tomography (CT) scan showed an extensive case of ARDS with pulmonary infiltrates affecting all lung fields (Figure 1). The Murray Score (1) was 3.5 and arterial blood gases (ABG) showed: pH 7.33, pO 2 40 mmHg, pCO 2 51 mmHg, HCO3 25 mmol/L, pO 2 /FiO 2 ratio 172 and evidence of mild tissue hypoxia (Lactate 3.4, SVO2 74.7, Table 1). Laboratory values revealed white blood count (WBC) 4.420 x 10 9 /l,C-Reactive Protein (CRP) 8,45 mg/dl, the cultural samples were collected and both the tracheal aspirate and the nasal swab tested were positive to Influenza A (not type H1N1). The patient had no other sign of systemic failure (PA 165/50 mmHg, HR 95 beats/min, diuresis 70 ml/h).

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Main Body Textmentioning

confidence: 99%

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Single or Double Site Cannuation for Veno-Venous Ecmo in Severe Obese Patient?

2016

ARC Journal of Anesthesiology

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“…, 3 The device is available in several sizes with the largest being 31FG in diameter and in separate lengths up to 31 cm long internally when measured from the skin. Venous drainage is done using two ports which are connected into one lumen.…”

Section: Introductionmentioning

confidence: 99%

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

Yastrebov

Kapalli

2013

Australas J Ultrason Med

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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.

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“…In light of these disadvantages, a single-cannula technique utilizing the internal jugular vein has come into favour [6]. The proprietary Avalon Elite Cannula incorporates two lumens, an outflow and an inflow, and when placed correctly, the outflow tract is positioned in the right atrium and the inflow in the vena cava with its openings at the superior and inferior vena cava to facilitate drainage.…”

mentioning

confidence: 99%

Safety of intensivist-led bedside decannulation of internal jugular bi-caval dual-lumen veno-venous extracorporeal membrane oxygenation cannulas and report of technique

Heller¹,

Dollerschell²,

Burk³

et al. 2016

Anaesthesiol Intensive Ther

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Background: In the past decade, the rate and utilization of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has increased dramatically. A single catheter technique has recently come into favour for providing VV-ECMO. Although it has been shown that intensivists can safely place these catheters, the safety of decannulation by intensivists has not been reported in the literature. Objective: We describe a technique for safely decannulating the Avalon Elite VV-ECMO catheter at the bedside and assess the safety of this technique, as compared with the standard technique of decannulation in the operating room by a surgeon. Methods: This was a retrospective cohort design conducted at a tertiary care cardiovascular intensive care unit at an academic medical centre. All patients who underwent VV-ECMO from 2009 to 2014 were included in the study except for those who had been decannulated for withdrawal of care. Complication rates from decannulation were compared between patients who were decannulated by surgeons in the operating room and those decannulated by intensivists in the intensive care unit (ICU). Results: Twenty-eight patients were included in this study, of whom twenty-three patients (82%) were decannulated by intensivists, board certified in Critical Care Medicine through the American Board of Anesthesiology, while five (18%) the patients were decannulated by a surgeon. There was no significant difference in the complications rates between the surgeons (0) and intensivists (1) (P = 1.00). There were no major complications requiring operative intervention associated with decannulation identified in this study. Conclusions: It is safe for intensivists to decannulate the Avalon Elite VV-ECMO cannula in the ICU using our purse-string suture technique. Performing these decannulations at the bedside compared to operating room may have positive clinical ramifications that include improved patient safety, timely patient care and reduced operating room costs.

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Use of Bicaval Dual-Lumen Catheter for Adult Venovenous Extracorporeal Membrane Oxygenation

Cited by 156 publications

References 9 publications

Single or Double Site Cannuation for Veno-Venous Ecmo in Severe Obese Patient?

Single or Double Site Cannuation for Veno-Venous Ecmo in Severe Obese Patient?

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

Safety of intensivist-led bedside decannulation of internal jugular bi-caval dual-lumen veno-venous extracorporeal membrane oxygenation cannulas and report of technique

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