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Safely repositioning dual-lumen ECMO cannulas with a transfemoral lasso snare
Erika R O'Neil1, Ryan D Coleman1, Adam M Vogel1,2
1Department of Pediatrics, Section of Critical Care, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA.
Introduction:
Dual-lumen cannulas were designed to provide venovenous extracorporeal membrane oxygenation (VV ECMO) with single-vessel access. Anatomic and size considerations may make appropriate placement challenging in children. Dual-lumen cannulas are repositioned in 20-69% of pediatric patients, which can be difficult without transient discontinuation of ECMO support.
Methods:
We repositioned three dual-lumen ECMO cannulas introduced via the right internal jugular vein using a transfemoral snare technique under real-time ultrasound and fluoroscopy.
Results:
Two of three patients were supported on VV ECMO and one on veno-veno-arterial (VV-A) ECMO. Two of the three patients had their dual-lumen cannula repositioned under ultrasound and fluoroscopy guidance and one was repositioned just with ultrasound. No patient experienced a complication from the transfemoral snare technique such as femoral hematoma, hemorrhage or limb ischemia.
Conclusion:
We describe three patients who successfully had dual-lumen cannulas repositioned without cessation of ECMO using a transfemoral "lasso" technique.
