The ProtekDuo as double lumen return cannula in V-VP ECMO configuration: A first-in-man method description

Maybauer, Marc O.; Koerner, Michael M.; Mihu, Mircea Radu; Harper, Michael S.; Banayosy, Aly El

doi:10.4103/aca.aca_49_21

Cited by 18 publications

(27 citation statements)

References 3 publications

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“…Blood was returned to the patient by splicing the return tubing, using a Y‐piece to flow blood through both lumen of the ProtekDuo. This method still provides reduced RV blood flow by about 40% and was sufficient offloading the RV in this patient 7 …”

mentioning

confidence: 72%

“…Maybauer et al recently published a novel method of veno‐venopulmonary (V‐VP) ECMO configuration, facilitating 7 LPM blood flow when using the ProtekDuo as double lumen return cannula, which resulted in significant increase in flow and oxygenation. 7 In this method, a 25 Fr multistage drainage cannula was inserted in a femoral vein leading blood through the oxygenator. Blood was returned to the patient by splicing the return tubing, using a Y‐piece to flow blood through both lumen of the ProtekDuo.…”

mentioning

confidence: 99%

“…This method still provides reduced RV blood flow by about 40% and was sufficient offloading the RV in this patient. 7 …”

mentioning

confidence: 99%

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The ProtekDuo cannula for extracorporeal membrane oxygenation: A game changer in COVID‐19!

2022

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confidence: 72%

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confidence: 99%

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The ProtekDuo cannula for extracorporeal membrane oxygenation: A game changer in COVID‐19!

2022

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“…After the pump, the tubing was spliced with a 3/8″ Y-connector and arterialized blood was returned to the patient through both lumina of the ProtekDuo with combined flow of up to seven LPM. 5 Given the length and diameter of the distal cannula, the flow distribution, as measured with ultrasonic flow probes, approximately averages 60% of blood flow through the proximal opening of the cannula in the RA, and approximately 40% of blood flow through the distal end in the PA. 6 With this partial decrease of RV preload by 40%, and partial decompression of the RV, these patients could be well managed. This study differs from those of Cain and Mustafa since the ProtekDuo was not used as an initial device, but after occurrence of either hypoxia secondary to inadequate ECMO flow relative to cardiac output or RV failure many weeks into the course of ECMO intervention.…”

Section: Discussionmentioning

confidence: 99%

“…We have also described a new method utilizing the ProtekDuo cannula as double lumen return cannula after placing a 25 Fr femoral drainage cannula (Veno-Venopulmonary (V-VP) ECMO configuration). 5,6 It was thought that these frequent adjustments were beneficial to our patients and, in view of this, the authors wished to review and share the knowledge gained from this experience. The data reported has been collected from our single center retrospective review of the ProtekDuo used in V-P and V-VP ECMO configuration in patients suffering from COVID-19 ARDS.…”

Section: Introductionmentioning

confidence: 99%

The ProtekDuo for percutaneous V-P and V-VP ECMO in patients with COVID-19 ARDS

et al. 2022

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Objective: The ProtekDuo with oxygenator mimics veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) in veno-pulmonary (V-P) configuration. We have recently developed a new configuration by utilizing a 25 Fr multistage femoral venous drainage cannula and by returning oxygenated blood through both lumina of the double lumen ProtekDuo cannula (V-VP configuration), thereby creating partial right ventricular bypass and oxygenated blood flow of up to seven LPM. We investigated our experience with V-P and V-VP ECMO in patients suffering from COVID-19 acute respiratory distress syndrome (ARDS). Methods: Single center, retrospective observational study. Results: Of nine patients, one was initiated on V-A, two on V-P, and six on V-V ECMO. All patients were reconfigured to V-P and five patients in addition had V-VP ECMO configuration. All patients had at least one and up to three circuit exchanges. Patients were on ECMO support between 20 and 122 (55 ± 29) days, were in ICU between 46 and 161 (78 ± 40) days with a total hospital length of stay between 35 and 171 (82 ± 42) days. Six of nine (67%) patients could successfully be weaned off ECMO, survived, and were discharged. Conclusion: The ProtekDuo cannula in V-P configuration provides ECMO blood flow while reducing RV flow, wall-stress and dilatation, as well as oxygen consumption. The V-VP configuration is useful to provide high blood flows of up to seven LPM of oxygenated blood, and partial RV support without over-circulating the pulmonary vascular bed. Our results show that V-P and V-VP ECMO configurations are feasible, have good outcome and are without complications.

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Arterial oxygen pressure during veno-venous extracorporeal membrane oxygenation may be increased by advancing the tip of the drainage cannula into the superior vena cava: a case report

Nakamura,

Kuriyama,

Hara

et al. 2024

J Artif Organs

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A simple and robust method for veno-venous extracorporeal membrane oxygenation (V–V ECMO) involves a drainage cannula into the inferior vena cava via the femoral vein (FV) and a reinfusion cannula into the right atrium (RA) via the internal jugular vein (IJV) (F–J configuration). However, with this method, the arterial oxygen (PaO2) is said to remain below 100 mmHg.Since recently, in our ICU, to prevent drainage failure, we apply a modification from the commonly practiced F–J configuration by advancing the tip of the drainage cannula inserted via the FV into the superior vena cava (SVC) and crossing the reinfusion cannula inserted via the IJV in the RA (F(SVC)–J(RA) configuration). We experienced that this modification can be associated with unexpectedly high PaO2 values, which here we investigated in detail.Veno-arteriovenous ECMO was induced in a 65-year-old male patient who suffered from repeated cardiac arrest due to acute respiratory distress syndrome. His chest X-ray images showed white-out after lung rest setting, consistent with near-absence of self-lung ventilation. Cardiac function recovered and the system was converted to F(SVC)–J(RA) configuration, after which both PaO2 and partial pressure of pulmonary arterial oxygen values remained high above 200 mmHg. Transesophageal echocardiography could not detect right-to-left shunt, and more efficient drainage of the native venous return flow compared to common F–J configuration may explain the increased PaO2.Although the F(SVC)-J(RA) configuration is a small modification of the F–J configuration, it seems to provide a revolutionary improvement in the ECMO field by combining robustness/simplicity with high PaO2 values.

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The ProtekDuo as double lumen return cannula in V-VP ECMO configuration: A first-in-man method description

Cited by 18 publications

References 3 publications

The ProtekDuo cannula for extracorporeal membrane oxygenation: A game changer in COVID‐19!

The ProtekDuo cannula for extracorporeal membrane oxygenation: A game changer in COVID‐19!

The ProtekDuo for percutaneous V-P and V-VP ECMO in patients with COVID-19 ARDS

Arterial oxygen pressure during veno-venous extracorporeal membrane oxygenation may be increased by advancing the tip of the drainage cannula into the superior vena cava: a case report

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