Safe ECMO femoral decannulation by placement of inferior vena cava filter via internal jugular vein

Abstract

Veno-arterial extracorporeal membrane oxygenation (ECMO) is a lifesaving treatment in patients with cardiogenic shock or cardiac arrest caused by massive pulmonary embolism. In these patients, positioning an inferior vena cava filter is often advisable, especially if deep venous thrombosis is not resolved at the time of the ECMO suspension. Moreover, in ECMO patients, a high incidence of deep venous thrombosis at the site of venous cannulation has been reported, and massive pulmonary embolism following ECMO decannulation has been described. Nonetheless, an inferior vena cava filter cannot be positioned as long as an ECMO cannula is inside the inferior vena cava. Thus, we developed a strategy to allow placement of an inferior vena cava filter through the internal jugular concurrently with the removal of the femoral venous ECMO cannula. In two women supported by veno-arterial ECMO for cardiac arrest secondary to pulmonary embolism, this novel approach allowed for safe ECMO decannulation.

Bedside intravascular ultrasound-guided fibrin sheath balloon maceration and inferior vena cava filter placement during extracorporeal membranous oxygenation decannulation

“…DVT has been reported to affect up to 18% of patients on venovenous ECMO, 5 although this number is likely underestimated and could result in death. [1][2][3] Additionally, authors have reported an increased risk of VTE in patients with ARDS owing to influenza A H1N1, which may be seen in other etiologies resulting in ARDS.…”

“…Given the frequent presence of deep vein thrombosis (DVT) in patients undergoing extracorporeal membranous oxygenation (ECMO), [1][2][3][4][5] inferior vena cava (IVC) filter placement can be performed in tandem with ECMO decannulation to avoid the potentially lethal complication of pulmonary embolism. 4,5 However, the presence of a fibrin sheath in the cava may complicate filter placement, leading to inadequate expansion of the filter struts and insufficient caval filtration. 6 This report describes the bedside use of a balloon catheter under intravascular ultrasound (IVUS) guidance to disrupt an ECMO cannularelated fibrin sheath and facilitate IVC filter placement.…”

HIT Syndrome Complicating Severe ARDS Requiring VV ECMO: A Case Report

“…Deep venous thrombosis is a known complication of ECMO due to prolonged periods of in situ cannulas, and there is a high risk of massive pulmonary embolism during decannulation. 9 Placement of an IVC filter prior to decannulation can prevent this complication.…”

Venous thromboembolic events in the setting of extracorporeal membrane oxygenation support in adults: A systematic review

“…Rare yet deadly types of VTE including inferior vena cava (IVC) and superior vena cava (SVC) thrombosis and even SVC syndrome in the setting of ECMO have also been reported in some case reports [21,30,31]. Risk of VTE is not only during the period of ECMO use, it is also seen after decannulation [32].…”

“…Moreover, recognizing risk factors may be beneficial in identifying high risk population, ensuring close monitoring, and having a low threshold to consider VTE in the differential diagnosis for these patients. Studies have also experimented with IVC filter placement during decannulation to prevent subsequent VTE in patients [75]. Seeing as many patients suffer thrombotic complications upon decannulation, this method could be useful in conjunction with other preventative measures.…”