Use of bicaval dual-lumen catheter for adult venovenous extracorporeal membrane oxygenation

Background: Extracorporeal membrane oxygenation (ECMO) provides supplementary oxygenation and carbon dioxide removal for selected patients on mechanical ventilatory support. Venovenous ECMO is traditionally established by dual cannulation of the internal jugular and femoral veins. We report our institutional experience using single-site, dual-lumen cannula for venovenous ECMO as an alternative to the 2-catheter approach. This approach minimizes recirculation and avoids use of the femoral site, which confers potential advantages. Methods: This is a retrospective review of a single institution's experience with a new bicaval dual lumen ECMO cannula. During a 19-month period, 27 consecutive patients were placed on ECMO using this catheter inserted through the right internal jugular vein. Results: Single-site venovenous ECMO support was uneventfully initiated in 26 of the 27 patients (median age, 42 years; interquartile range, 31 to 58 years) and achieved full flows and adequate gas exchange. Median ventilator days before ECMO was 1 day (interquartile range, 0.25 to 3.5 days). The median duration of ECMO support was 9 days (interquartile range, 5.5 to 11.5 days). Decannulation was achieved in 70% of the patients and extubation in 59%. Two were bridged to lung transplantation and are still alive. The overall survival and hospital discharge rate was 56%. There was no device failure or in-cannula thrombosis. One superior vena cava injury occurred, and one cannula required repositioning. Conclusions: Single-site venovenous ECMO has advantages compared with traditional venovenous ECMO. Using image guidance, the cannula can reliably be used in prolonged venovenous ECMO cases.