The use of double lumen cannula for veno-venous ECMO in trauma patients with ARDS

Abstract

BackgroundThe use of a double lumen cannula for veno-venous extracorporeal membrane oxygenation (v.v. ECMO) offers several advantages such as cannulation with only one cannula, patient comfort and the earlier mobilization and physiotherapy. The cannulation should be performed under visual wire and cannula placement into the right atrium, which is associated with risks of malposition and right ventricular perforation. The aim of this patient series is to describe the use of double lumen cannula in trauma patients with posttraumatic ARDS.Material and methodsCriteria for the v.v ECMO treatment were defined as hypoxaemia (pO2/FiO2 < 200 mmHg, FiO2 0.8-1,0); tidal volume >4-6 ml/kg ideal body weight; mean inspiratory pressure (Pinsp) >32-34 mmHg; respiratory acidosis pH <7.25; and arterial saturation (SaO2) <90%. The analysis included the Injury Severity Score (ISS), the types of injury, time of treatment, complications and outcomes.ResultsA total of 24 patients with major trauma were treated for posttraumatic ARDS with v.v. ECMO. The double lumen cannula (Avalon®, Fa. Maquet, Rastatt, Germany) was used in six male patients. The mean ISS was 31 (20–48). The ECMO therapy was started in an average on the third day after trauma. The mean ECMO run time was 7 days ± 5 (6–18), and the hospital stay was in mean of 60 days ± 34 (21–105).ConclusionThe use of double lumen cannula for v.v ECMO therapy in trauma patients is a feasible treatment option. No higher risk of bleeding could be found in this case series. A PTT-controlled heparinization is recommended using double lumen cannula. Therefore the use of this cannula type in trauma patients with high risk of bleeding is to discuss controversially.

Extracorporeal Membrane Oxygenation in Traumatic Injury: An Overview of Utility and Indications

“…The patient subsequently improved, was successfully weaned from VV-ECMO after 1 week, and was eventually transferred to a rehabilitation facility [44]. In another report, a small subset of patients with spinal cord injury underwent VV-ECMO for post-traumatic ARDS, without reported neurologic sequelae [40].…”

“…Thus, providers may need to be flexible in terms of vascular access options for ECMO. For example, cervical spine injury in the trauma patient may preclude internal jugular cannulation [40]. Moreover, significant pelvic or lower extremity fractures may preclude accessing the femoral vessels [41].…”

“…Gothner et al [40] published clinical experience based on six patients with major trauma (mean injury severity score [ISS], 31) and post-traumatic severe respiratory failure who were supported with VV-ECMO using a double lumen cannula. The authors reported mean pre-ECMO hospitalization of 3 days, mean ECMO run times of 7 days, mean hospital stays of 60 days, and 100% survival for the 6 study patients [40]. It was noted that the double lumen cannula utilized was not heparin coated and thus heparin dosages had to be adjusted to maintain the prothrombin time (PTT) in the range of 50-60.…”

Extracorporeal support in airway surgery

“…It is a good alternative to the standard two-cannula approach. With the growing experience of using these cannulas in ARDS and lung transplant patients, they have also been adopted in airway surgery (43,44). The placement of the cannula in the right atrium requires fluoroscopic (preferably) or TEE guidance (45).…”

Anatomic changes after repair of traumatic bilateral diaphragmatic rupture impede bi-caval dual lumen catheter insertion for veno-venous extracorporeal membrane oxygenation treatment

“…Choosing an adequate cannula type and insertion site can be a challenge. The insertion of a bi-caval dual lumen (Avalon®) catheter in the superior vena cava instead of two venous single-lumen catheters facilitates mobilisation and physiotherapy of patients, and hence is being used more and more [1]. …”