1063

Abstract

Introduction: The purpose of this study is to evaluate the potential for using transthoracic echocardiography (TTE) as an alternative modality to assist in placement of venovenous double lumen bicaval catheters via the internal jugular (IJ) approach. Hypothesis: Currently TTE or fluoroscopy are used to assist in placement of VV ECMO cannulae. The hypothesis of this study is there is no increased complication rate using bedside TTE performed by trained critical care specialists for this procedure. Methods: This is a retrospective cohort of adult patients admitted with refractory respiratory failure at two tertiary hospitals of the Montefiore Medical Center, Bronx, New York. The inclusion criterion was patients placed on VV ECMO using TTE to assist in placement of the cannula. Venous cannulation was achieved with the aid of ultrasound guidance of the right IJ vein. The Avalon Elite® Dual Lumen Bicaval catheter was placed by a cardiothoracic surgeon. The guidewire was identified at the IVC/right atrial junction via transthoracic echococardiographic views obtained by an intensivist. The proper ECMO cannula position was confirmed at the level of the tricuspid valve via a transthoracic echocardiographic view with the aid of color Doppler flow. A chest radiograph was obtained to rule out pneumothorax post cannula insertion. Results: Between June 1, 2009 and August 20, 2012, there were 5 cases of VV ECMO via the right IJ approach performed at the bedside assisted by TTE performed by trained intensivists. The median (IQR) age was 27 (23, 44) years, 57% were men and 57% were African American. The median (IQR) body mass index was 25 (23, 32). Two patients had ARDS, two had status asthmaticus and one had pulmonary edema. The mean+/-SD PF ratio was 48+/-8 in the ARDS group and 67 in the patient with pulmonary edema. The pCO2 was 113 and 148 in the group with status asthmaticus. The median (IQR) hospital length of stay was 12(9,54) days. All patients survived with no complications related to catheter placement or while on ECMO. The crude 90-day mortality was zero (n=4, one patient has not reached 90-days). Conclusions: TTE performed by an intensivist presents a viable option to aid in VV ECMO cannulation.