Modifying veno - venous extra corporeal membrane oxygenation management for situs inversus totalis - A case report

IntroductionSitus inversus totalis is a rare condition affecting 1 in 10,000 individuals, in which the heart and abdominal organs are reversed. This mirrored arrangement of the great vessels presents unique challenges for vascular access during extracorporeal membrane oxygenation (ECMO).Case ReportA 41-year-old male presented with a fever, cough, and shortness of breath. Initial chest radiography revealed bilateral infiltrates (right more than left) and dextrocardia, while computed tomography of the chest and abdomen confirmed situs inversus totalis. The patient required venovenous ECMO for refractory hypoxemia. The ECMO setup was modified with an access cannula placed in the left femoral vein and a return cannula inserted into the left internal jugular vein. Bronchoscopy performed for lung collapse revealed a bilobed right lung and trilobed left lung. After clinical improvement, ECMO support was weaned off after 9 days, and the patient was discharged after 28 days.ConclusionModifying the ECMO setup and adjusting management strategies are crucial for treating refractory hypoxemia in patients with situs inversus.