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Inferior vena cava surgical cannulation for infants needing veno-venous extracorporeal membrane oxygenation
Gennaro Martucci1, Fabrizio di Francesco2, Giovanna Panarello1
1Department of Anesthesia and Intensive Care, IRCCS-ISMETT, Palermo, Italy.
Insights
In infants needing prolonged extracorporeal membrane oxygenation (ECMO), a dual venous cannula approach via the iliac vein can ensure adequate blood flow when standard jugular cannulation is insufficient.
Area of Science:
- Pediatric critical care medicine
- Cardiopulmonary support technologies
- Vascular access techniques
Background:
- Femoral venous cannulation for veno-venous extracorporeal membrane oxygenation (ECMO) presents challenges in infants due to limited vessel diameter.
- Acute respiratory distress syndrome (ARDS) in infants necessitates advanced respiratory support.
Observation:
- An 8-month-old infant (8 kg) with H1N1-induced ARDS required prolonged ECMO support (67 days).
- Initial internal jugular vein cannulation proved insufficient after 30 days, necessitating a second cannula.
- A 12 Fr single-lumen cannula was surgically placed in the right common iliac vein to augment flow.
Findings:
- The dual caval configuration, including the surgically placed iliac vein cannula, achieved an excellent flow profile.
- ECMO support was successfully continued for an additional 37 days, leading to a positive outcome.
- This approach optimized blood flow and oxygenation during prolonged ECMO.
Implications:
- Surgical cannulation of the inferior vena cava (IVC) is a viable and safe option in pediatric patients requiring ECMO.
- This strategy is particularly useful when appropriate-sized cannulas are scarce or central venous access is difficult.
- The double caval configuration offers a life-saving solution for complex pediatric ECMO cases, balancing risks and benefits.
Introduction:
Femoral cannulation for veno-venous extracorporeal membrane oxygenation is challenging in infants because of the diameter of the vein.
Case Report:
Prolonged ECMO support (67 days) was necessary for an 8-month-old (8 kg) girl with acute respiratory distress syndrome that was caused by H1N1 influenza. After 30 days on ECMO support and using a single 16 Fr double-lumen cannula (internal jugular vein), a second cannula was necessary to ensure adequate flow. This second 12 Fr single-lumen cannula was surgically placed through the right common iliac vein. An excellent flow profile was then achieved and ECMO continued successfully for 37 more days.
Discussion:
As a lifesaving option, this double caval configuration successfully optimized the flow profile and oxygenation, outweighing the related risks.
Conclusion:
In small children, a surgical approach to the inferior vena cava can be considered safe, especially in those cases where there is a shortage of adequate cannulas, or when central venous access is difficult.
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