Alternative venous access sites for dual-lumen extracorporeal membrane oxygenation cannulation.

Abstract

Dual-lumen cannulas for veno-venous (VV) extracorporeal membrane oxygenation (ECMO) support are typically inserted in the right internal jugular vein (RIJV), however some scenarios can make this venous route inaccessible. This multicentre case series aims to evaluate if single site cannulation using an alternative venous access is safe and feasible in patients with an inaccessible RIJV. We performed a multi-institutional retrospective analysis including high-volume ECMO centers with substantial experience in dual-lumen cannulation (DLC) (defined as > 10 DLC per year). Three centers ((Freiburg (Germany), Toronto (Canada) and Vienna (Austria)) agreed to share their data, including baseline characteristics, technical ECMO and cannulation data as well as complications related to ECMO cannulation and outcome. A total of 20 patients received alternative DLC for respiratory failure. Cannula insertion sites included the left internal jugular vein (n = 5), the right (n = 7) or left (n = 3) subclavian vein and the right (n = 4) or left (n = 1) femoral vein. Median cannula size was 26 (19-28) French. Median initial target ECMO flow was 2.9 (1.8-3.1) L/min and corresponded with used cannula size and estimated cardiac output. No procedural complications were reported during cannulation and median ECMO runtime was 15 (9-22) days. Ten patients were successfully bridged to lung transplantation (n = 5) or lung recovery (n = 5). Ten patients died during or after ECMO support. Alternative venous access sites for single site dual-lumen catheters are a safe and feasible option to provide VV-ECMO support to patients with inaccessible RIJV.