Extracorporeal Membrane Oxygenator Rotational Cannula Catastrophe: A Role of Echocardiography in Rescue

Bicaval dual lumen cannula placement using transthoracic echocardiography in COVID-19 scenario: pearls and pitfalls

“… 8 11 17 Rotational dislocation occurs when the middle port is not oriented towards the tricuspid valve, leading to the returning oxygenated blood impinging the right atrial wall rather than flowing towards the right ventricular inlet. This dislocation is unique to the Avalon cannula and usually discovered by four chamber view of TOE due to its high-quality resolution, 10 18 but can be still detected by subcostal four chamber view, as described in our case. We have summarised possible complications and their respective solutions in table 1 and suggested a protocol to avoid complications related to cannula malposition in table 2 .…”

“…Apart from complications seen in traditional ECMO configurations, malposition is the notable complication when using Avalon cannula and can occur during Avalon cannula insertion or after the procedure 8–10. During the procedure, advancing the cannula from the SVC passing through the right atrium down to the IVC is a key step which crucially requires correct prior placement of the guidewire.…”

Hemodynamic stability following incidental cardiac perforation on extracorporeal life support

“…Malposition of venous cannula will result in poor venous drainage and it can cause mechanical complications. [4] Under cardiopulmonary resuscitation situation, femoral vessels are usually available during chest compression. These vessels are preferred for cannulation for extracorporeal circulation.…”

Reducing the Risk of Cardiac Perforation During Placement of Bicaval Veno-Venous Extracorporeal Membrane Oxygenation Cannulae

“…Cannula placement for veno-venous extracorporeal membrane oxygenation (VV-ECMO) is not without risk, and cannulation-associated complications can result in significant patient harm. 1 The letter by Banayan et al demonstrates the catastrophic consequences of cardiac perforation during dual lumen bicaval cannula placement, but the true incidence of this complication remains unknown. 2 Echocardiography plays a key role in confirming guidewire placement, and its utility with regards reducing the incidence of cardiac perforation is widely accepted.…”

“…Superiority of preservation of subvalvular structures over the conventional valve-excising technique during mitral valve replacement is now well established. 1,2 Even though bileaflet preservation offers much better preservation of native valve physiology, it is technically more difficult, prolongs surgery, fits in a smaller prosthetic valve, and opens the possibilities of complications like left ventricular outflow tract obstruction, contact between the prosthetic valve and subvalvular structures causing mitral inflow obstruction, and even valve thrombosis. 3,4 Most cardiac surgeons thus prefer to preserve the posterior leaflet alone.…”