Migrated Avalon-Elite cannula in an infant transcatheter repositioning without interruption of ECMO flow

Inadvertent migration of Avalon-Elite cannula in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) support is often difficult to manage. Cannula repositioning conventionally requires temporary discontinuation of the ECMO support which is often poorly tolerated in small infants with poor pulmonary reserve. We reported a case of a small infant weighing 3.9 kg requiring VV-ECMO support with a 13Fr Avalon-Elite cannula for respiratory failure secondary to severe pneumonitis, complicated by 2 episodes of cannula migration which were both successfully managed by transcatheter repositioning in the cardiac catheterization laboratory without interruption of ECMO flow.