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

Charlesworth, M.; Ashworth, Alan

doi:10.1053/j.jvca.2017.09.003

Cited by 4 publications

(2 citation statements)

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“…Most of the ECMO packages contain soft, flexible guidewires, as opposed to more stiff guidewires often used in interventional cardiology procedures. The lack of rigidity of these guidewires may result in greater chance of intravascular or intracardiac "looping" that directs the dilators and cannulas toward the cardiac wall, and increasing risk of perforation [8]. Some studies have reported no significant changes in flow through mispositioned cannula therefore we should not solely rely on flow characteristics to identify proper placement [4].…”

Section: Discussionmentioning

confidence: 99%

“…Implementation of frequent echocardiograms, during and after cannula placement, can potentially identify these minor position changes that can lead to detrimental complications. Additionally, some experts have suggested the use of fluoroscopy, if available, during cannulation to decrease risk [8,12]. Transferring a patient to a fluoroscopy suite may not be feasible when the patient is unstable and minimizing radiation exposure should be considered.…”

Section: Discussionmentioning

confidence: 99%

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Right Atrial Perforation Leading to Cardiac Tamponade Following Veno-Venous Extracorporeal Membrane Oxygenation Cannulation

Sandhu

Dean

Landsberg

2021

Cureus

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Extracorporeal membrane oxygenation (ECMO), as a supportive modality for cardiopulmonary failure, is increasing in its use due to improved advances in technology and experience lending to availability and ease of implementation. Complications with ECMO are quite common, and with increasing use, an increase in complications are a natural result. These complications can be from the underlying disease process or from the ECMO process itself, including cannula insertion. One such complication includes perforation of surrounding structures at site of insertion. We will present a case of right atrial perforation after single lumen cannula insertion, which led to development of cardiac tamponade and subsequently cardiac arrest. In addition to cannula design, lack of wire rigidity can play a role in wire migration and injury to surrounding structures. We emphasize the importance of ultrasound guidance and surveillance with echocardiogram or fluoroscopy during ECMO cannulation, regardless of cannula type, to prevent fatal complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%