Acute Crit Care.  2020 Aug;35(3):207-212. 10.4266/acc.2019.00584.

Percutaneous bicaval dual lumen cannula for extracorporeal life support

• Kim W
• Kwon HW
• Min J
• Cho S
• Kwak JG
• Park JD
• Kim WH

• KMID: 2506101
• DOI: http://doi.org/10.4266/acc.2019.00584

Abstract

Veno-venous extracorporeal membrane oxygenation (ECMO) is a useful mechanical device for pediatric patients with severe respiratory failure. Conventional veno-venous ECMO using double cannulation, however, is not feasible due to size limitations in pediatric patients who have small femoral vessels. Recently, percutaneous bicaval dual-lumen cannula can be inserted using single cannulation via the right internal jugular vein. Herein, we report the case of a pediatric patient with severe respiratory failure who was weaned off the ECMO successfully after treatment with bicaval dual-lumen cannulation for 5 days despite the small body size and immunocompromised condition due to chemotherapy for hemophagocytic lymphohistiocytosis.

Keyword

extracorporeal membrane oxygenation; pediatrics; respiratory insufficiency

Figure

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  Figure 1. Chest X-ray images showing rapid progression of bilateral lung haziness (A: HD 78, B: HD 84), and (C, D) a chest computed tomography images showing increased bronchovascular bundle thickening in both lungs (HD 85 at 1 week before extracorporeal membrane oxygenation insertion). HD: hospital day.

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  Figure 2. After checking the cannula in the right ventricle on chest X-ray (A), the cannula was repositioned to the inferior vena cava (B).

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  Figure 3. Graph showing the flow of extracorporeal membrane oxygenation and revolution per minute for 5 days.

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  Figure 4. Chest X-ray image showing improved bilateral lung haziness. Chest X-ray just before (A) and after (B) decannulation.

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  Figure 5. The bicaval dual lumen cannula is designed for low recirculation and has a wire-covered double lumen to prevent kinking. The return hole should be placed toward the tricuspid valve (white arrow), and the drain hole in the superior vena cava and inferior vena cava (black arrows).

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