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Noe C, Rottmann FA, Bemtgen X, Supady A, Wengenmayer T, Staudacher DL. Dual lumen cannulation and mobilization of patients with venovenous extracorporeal membrane oxygenation. Artif Organs 2023; 47:1654-1662. [PMID: 37358935 DOI: 10.1111/aor.14604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Mobilization is important in longer courses in intensive care unit (ICU), typical for patients requiring venovenous extracorporeal membrane oxygenation (V-V ECMO). For patients supported with ECMO, especially out-of-bed mobilizations improve outcome. We hypothesized that utilization of a dual lumen cannula (DLC) for V-V ECMO would facilitate out-of-bed mobilization compared to single lumen cannulas (SLC). METHODS Retrospective single center registry study including all V-V ECMO patients cannulated between 10/2010 and 05/2021 for respiratory failure. RESULTS The registry included 355 V-V ECMO patients (median age 55.6 years, 31.8% female, 27.3% with preexisting pulmonary disease), 289/355 (81.4%) primary cannulated with DLC, and 66/355 (18.6%) using SLC. Both groups had similar pre-ECMO characteristics. The runtime of the first ECMO cannula was significantly longer in DLC compared to SLC (169 vs. 115 h, p = 0.015). The frequency of prone positioning during V-V ECMO was similar in both groups (38.4 vs. 34.8%, p = 0.673). There was no difference in in-bed mobilization (41.2 vs. 36.4%, for DLC and SLC, respectively, p = 0.491). Patients with DLC were more often mobilized out-of-bed (25.6 vs. 12.1%, OR 2.495 [95% CI 1.150 to 5.268], for DLC and SLC, respectively, p = 0.023). Hospital survival was similar in both groups (46.4 vs. 39.4%, for DLC and SLC, respectively, p = 0.339). CONCLUSION Patients cannulated with a dual lumen cannula for V-V ECMO support were significantly more often mobilized out-of-bed. Since mobilization is important in prolonged ICU courses typical for ECMO patients, this might be an important benefit. Other benefits of DLC were the longer runtime of the initial cannula set and fewer suction events.
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Affiliation(s)
- Christian Noe
- Interdisciplinary Medical Intensive Care, Faculty of Medicine, University of Freiburg Medical Center, University of Freiburg, Freiburg, Germany
| | - Felix A Rottmann
- Department of Medicine IV - Nephrology and Primary Care, Faculty of Medicine, University of Freiburg Medical Center, University of Freiburg, Freiburg, Germany
| | - Xavier Bemtgen
- Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg Medical Center, University of Freiburg, Freiburg, Germany
| | - Alexander Supady
- Interdisciplinary Medical Intensive Care, Faculty of Medicine, University of Freiburg Medical Center, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Interdisciplinary Medical Intensive Care, Faculty of Medicine, University of Freiburg Medical Center, University of Freiburg, Freiburg, Germany
| | - Dawid L Staudacher
- Interdisciplinary Medical Intensive Care, Faculty of Medicine, University of Freiburg Medical Center, University of Freiburg, Freiburg, Germany
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2
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Muhammad H, L'Huillier JC, Benson Ham P, Vali K. Strategies for appropriate positioning and repositioning the Avalon ECMO cannula in a 17-year-old with left hepatic vein malposition. Perfusion 2023; 38:645-650. [PMID: 34927476 DOI: 10.1177/02676591211063829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is a well-recognized therapy in children with refractory hypoxia. Different cannulas have been used with reported complications with placement, such as cardiac perforation, and multiple reports focusing on avoiding this. However, strategies to avoid hepatic vein cannulation and reposition when it occurs are not well described. CASE REPORT Here, we report a case where a 27-Fr Avalon bicaval double lumen cannula in the left hepatic vein was successfully repositioning using serial chest X-rays (CXR) and transthoracic echocardiography (TTE) in a 17-year-old female. DISCUSSION While venovenous (VV) ECMO is preferred by many, placement of the Avalon catheter, a cannula available for VV ECMO, may be challenging due to migration or positioning issues. Specific techniques of wire and catheter advancement as well as confirming wire position in the infra-hepatic inferior vena cava can help ensure appropriate positioning while avoiding hepatic vein cannulation and enabling successful repositioning when it occurs. CONCLUSION Wire position in the infra-hepatic inferior vena cava helps ensure safe and appropriate Avalon cannula position and placement. The Avalon cannula can be successfully repositioned from the left hepatic vein by retracting the cannula, reinserting the wire and introducer together, and then manipulation techniques using serial CXR and TTE.
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Affiliation(s)
- Haris Muhammad
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA
| | - Joseph C L'Huillier
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA.,Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Phillip Benson Ham
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA.,Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Kaveh Vali
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA.,Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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3
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Dotiwala A, Kalakoti P, Grier LR, Quispe M, Scott LK, Conrad SA, Samra NS. Penetrating thoracic injury requiring emergency pneumonectomy supported with two ECMO runs: A testament to multidisciplinary critical care medicine. Trauma Case Rep 2023; 44:100779. [PMID: 36785783 PMCID: PMC9920248 DOI: 10.1016/j.tcr.2023.100779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
Post-traumatic pneumonectomies are uncommon and, if necessary, carry significant mortality. The use of extracorporeal membrane oxygenation (ECMO) for lung injury in trauma patient has demonstrated efficacy with minimal bleeding complications. We report a case of a young man with a penetrating thoracic injury that required a pneumonectomy supported with two separate ECMO runs for pulmonary failure postoperatively.
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Affiliation(s)
- Aryeneesh Dotiwala
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Department of General Surgery, LSU Health - Shreveport, Shreveport, LA, United States
| | - Piyush Kalakoti
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - Laurie R. Grier
- Department of Emergency Medicine, LSU Health - Shreveport, Shreveport, LA, United States
| | - Marco Quispe
- Department of Emergency Medicine, LSU Health - Shreveport, Shreveport, LA, United States
| | - L. Keith Scott
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Department of General Surgery, LSU Health - Shreveport, Shreveport, LA, United States
- Department of Emergency Medicine, LSU Health - Shreveport, Shreveport, LA, United States
| | - Steven A. Conrad
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Department of General Surgery, LSU Health - Shreveport, Shreveport, LA, United States
- Department of Emergency Medicine, LSU Health - Shreveport, Shreveport, LA, United States
| | - Navdeep S. Samra
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Department of General Surgery, LSU Health - Shreveport, Shreveport, LA, United States
- Corresponding author at: Department of Surgery, Division of Trauma and Surgical Critical Care, LSU Health – Shreveport, Shreveport, LA 71103, United States.
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Weidemann F, Decker S, Epping J, Örgel M, Krettek C, Kühn C, Wilhelmi M. Analysis of extracorporeal membrane oxygenation in trauma patients with acute respiratory distress syndrome: A case series. Int J Artif Organs 2021; 45:81-88. [PMID: 33438507 DOI: 10.1177/0391398820980736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Thoracic trauma is the most common injury in polytrauma patients. Often associated with the development of an acute respiratory distress syndrome (ARDS), conservative treatment options are very restricted and reach their limits quickly. OBJECTIVE Extracorporeal membrane oxygenation (ECMO) is a wellestablished therapy in cardio-thoracic surgery and internal medicine intensive care units. The purpose of this study is to analyse the potential benefit of ECMO therapy in ARDS treatment in polytrauma patients. DESIGN Retrospective case series. SETTING Level 1 trauma centre, Germany, 04/2011-04/2019. PATIENTS Nineteen patients with ARDS treated with a veno-venous ECMO system. MAIN OUTCOME MEASURES This study focused on the time leading to therapy initiation, the severity of thoracic and overall injury. The Sequential Organ Failure Assessment (SOFA) Score, the Murray Score, the Abbreviated Injury Scale (AIS) 2005 level and the Injury Severity Score (ISS) were analysed. The results were analysed regarding survival and death. RESULTS The survival rate was 53%. The ISS was the same for survivors and deceased patients (p = 0.604). Early initiation of ECMO therapy showed a significant trend for survivors (p = 0.071). The SOFA Score level before ECMO therapy was significantly lower in the survivors than in those who died (p = 0.035). The AISThorax level for survivors showed a significantly higher score level than the one for deceased patients (p = 0.05). CONCLUSION ECMO therapy in polytrauma patients is a safe and effective option, in particular when used early in ARDS treatment. The overall severity of organ failure determined the likelihood of survival rather than the thoracic trauma itself.
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Affiliation(s)
| | | | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - Marcus Örgel
- Trauma Department, Hannover Medical School, Hannover, Germany
| | | | - Christian Kühn
- Department of Cardiothoracic-, Transplant-, and Vascular Surgery, Hannover Medical School, Hannover, Germany
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5
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Natanov R, Khalikov A, Gueler F, Maus U, Boyle EC, Haverich A, Kühn C, Madrahimov N. Four hours of veno-venous extracorporeal membrane oxygenation using bi-caval cannulation affects kidney function and induces moderate lung damage in a mouse model. Intensive Care Med Exp 2019; 7:72. [PMID: 31845103 PMCID: PMC6915191 DOI: 10.1186/s40635-019-0285-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/27/2019] [Indexed: 12/15/2022] Open
Abstract
Background Improvement of single site cannulation for extracorporeal membrane oxygenation (ECMO) therapy is pivotal for reduction of patient morbidity and mortality in respiratory failure. To further improve the cardiopulmonary outcomes and reduce end organ damage, we established a murine model for single site cannulation with a double lumen cannula. Results We created a hemodynamically stable double lumen cannula and successfully implanted it through the jugular vein into the upper and lower vena cava. This allowed adequate drainage of the blood. Blood gas analysis showed excellent oxygenation and CO2 reduction. There was no excessive bleeding. No signs of right heart congestion were present which was confirmed in the histological analysis of the liver. Histology demonstrated moderate lung damage and mild acute kidney injury. Neutrophil infiltration was similar in ECMO and sham kidneys. Conclusions Veno-venous extracorporeal circulation deteriorates kidney function and promotes moderate pulmonary damage.
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Affiliation(s)
- Ruslan Natanov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Abdurasul Khalikov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Ulrich Maus
- Department of Pneumology, Hannover Medical School, Hannover, Germany
| | - Erin C Boyle
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Kühn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nodir Madrahimov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. .,Clinic of Cardiothoracic Surgery, University Clinic of Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany.
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Amos T, Yeung M, Gooi J, Fitzgerald M. Survival following traumatic thoracic compartment syndrome managed with VV-ECMO. Trauma Case Rep 2019; 24:100249. [PMID: 31872022 PMCID: PMC6911920 DOI: 10.1016/j.tcr.2019.100249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/13/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022] Open
Abstract
Whilst post-traumatic respiratory failure is the most common indication for use of VV-ECMO in trauma patients, its use in traumatic thoracic compartment syndrome is not yet well described. Thoracic compartment syndrome, a rare complication of thoracic trauma, occurs in the setting of chest wall injuries, impaired chest wall compliance, pulmonary contusions and subsequent high ventilatory pressures. This in turn impairs venous return and increases risk of circulatory arrest due to obstructive shock. This case study describes the successful use of VV-ECMO in a young male with thoracic compartment syndrome following severe blunt chest trauma sustained in a high speed motor vehicle crash. Following brief circulatory arrest, thoracic compartment syndrome was relieved during thoracotomy but reoccurred on chest closure. The use of VV-ECMO for oxygenation permitted lower ventilatory pressures, allowing venous return and primary closure of the thoracotomy. The patient subsequently had an excellent functional outcome. This case describes the successful use of VV-ECMO for a novel indication. The indications for ECMO in thoracic trauma patients continue to evolve.
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Affiliation(s)
- Timothy Amos
- National Trauma Research Institute, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Meei Yeung
- Trauma Services, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Australia
| | - Julian Gooi
- Cardiothoracic Surgery Unit, The Alfred Hospital, Victoria, Australia
| | - Mark Fitzgerald
- Trauma Services, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Australia.,Monash University School of Medicine, Melbourne, Victoria, Australia
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Large Dual-Lumen Extracorporeal Membrane Oxygenation Cannulas Are Associated with More Intracranial Hemorrhage. ASAIO J 2019; 65:674-677. [DOI: 10.1097/mat.0000000000000917] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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8
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Assessment of safety and bleeding risk in the use of extracorporeal membrane oxygenation for multitrauma patients: A multicenter review. J Trauma Acute Care Surg 2019; 86:967-973. [DOI: 10.1097/ta.0000000000002242] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Zonies D, Codner P, Park P, Martin ND, Lissauer M, Evans S, Cocanour C, Brasel K. AAST Critical Care Committee clinical consensus: ECMO, nutrition. Trauma Surg Acute Care Open 2019; 4:e000304. [PMID: 31058243 PMCID: PMC6461143 DOI: 10.1136/tsaco-2019-000304] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 01/15/2023] Open
Abstract
The American Association for the Surgery of Trauma Critical Care Committee has developed clinical consensus guides to help with practical answers based on the best evidence available. These are focused in areas in which the levels of evidence may not be that strong and are based on a combination of expert consensus and research. Overall, quality of the research is mixed, with many studies suffering from small numbers and issues with bias. The first two of these focus on the use of extracorporeal membrane oxygenation in trauma patients and nutrition for the critically ill surgical/trauma patient.
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Affiliation(s)
- David Zonies
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Panna Codner
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pauline Park
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Niels D Martin
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Lissauer
- Department of Surgery, Rutgers-Robert Wood Johnson, Rutgers, New Jersey, USA
| | - Susan Evans
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Christine Cocanour
- Department of Surgery, University of California Davis, Davis, California, USA
| | - Karen Brasel
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
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10
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Biffi S, Di Bella S, Scaravilli V, Peri AM, Grasselli G, Alagna L, Pesenti A, Gori A. Infections during extracorporeal membrane oxygenation: epidemiology, risk factors, pathogenesis and prevention. Int J Antimicrob Agents 2017; 50:9-16. [DOI: 10.1016/j.ijantimicag.2017.02.025] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/17/2017] [Accepted: 02/24/2017] [Indexed: 11/27/2022]
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Hoetzenecker K, Klepetko W, Keshavjee S, Cypel M. Extracorporeal support in airway surgery. J Thorac Dis 2017; 9:2108-2117. [PMID: 28840012 DOI: 10.21037/jtd.2017.06.17] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Extracorporeal life support (ECLS) is increasingly used for major airway surgery. It facilitates complex reconstructions and maintains gas exchange during endoscopic procedures in patients with critical airway obstruction. ECLS offers the advantage of an uncluttered surgical field and eliminates the need for crossing ventilation tubes, thus, making precise surgical dissection easier. ECLS is currently used for hemodynamic and respiratory support in lung transplantation as well as extended tumor resections with an acceptable risk profile. This work reviews the published experience of ECLS in airway surgery both in adults and in pediatric patients. It highlights currently available devices and their indications.
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Affiliation(s)
- Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University Health Network, Toronto, Canada
| | - Marcelo Cypel
- Division of Thoracic Surgery, University Health Network, Toronto, Canada
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Hollinger A, Tuchscherer D, Bremerich J, Siegemund M. Anatomic changes after repair of traumatic bilateral diaphragmatic rupture impede bi-caval dual lumen catheter insertion for veno-venous extracorporeal membrane oxygenation treatment. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:80. [PMID: 28372577 PMCID: PMC5379599 DOI: 10.1186/s13054-017-1667-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Alexa Hollinger
- Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland.
| | - Daniel Tuchscherer
- Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland
| | - Jens Bremerich
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland
| | - Martin Siegemund
- Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland
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Palizas F, García CC, Norese M. Use of a dual lumen cannula for venovenous extra corporeal membrane oxygenation in a patient with acute respiratory distress syndrome and a previously inserted inferior vena cava filter: a case report. Rev Bras Ter Intensiva 2017; 28:78-82. [PMID: 27096680 PMCID: PMC4828095 DOI: 10.5935/0103-507x.20160001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/09/2015] [Indexed: 11/20/2022] Open
Abstract
Extracorporeal membrane oxygenation is used in refractory hypoxemia in many
clinical settings. Thoracic trauma patients usually develop acute respiratory
distress syndrome. Due to high risk of bleeding, thrombotic complications
present in this context are particularly difficult to manage and usually require
insertion of an inferior vena cava filter to prevent embolism from the distal
veins to the pulmonary circulation. Here, we present a case of a thoracic trauma
patient with severe acute respiratory distress syndrome requiring venovenous
extracorporeal membrane oxygenation via a right internal jugular double lumen
cannula due to a previously inserted inferior vena cava filter caused by distal
bilateral calf muscle vein deep vein thrombosis.
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