Myocardial infarction due to malposition of ECMO cannula
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KeywordsInferior Vena Extracorporal Membrane Oxygenation Caval Vein Inferior Caval Vein Emergency Coronary Angiography
The most reported complications of veno-venous extracorporal membrane oxygenation (ECMO) are bleeding and infections . Recently, a double lumen cannula was introduced, making introduction of two separated cannulas unnecessary. This single cannula is inserted via the right internal jugular vein and positioned with the tip resting in the inferior vena cava. Through ports in the superior and inferior caval veins, blood is returned directly into the right atrium. There have been reports describing ambulatory patients on veno-venous ECMO  with this type of cannula.
To date, only “minor” complications have been described such as displacement of the cannula tip from the inferior vena cava into the right atrium .
Here we describe a case of a displaced Avalon double lumen cannula, which caused compression of the right coronary artery, 14 days after initiation of ECMO.
A 61-year-old (height 1.80 m) man suffering from severe H1N1 pneumonitis for 4 days was referred to our tertiary center for ECMO. One day after admission at our center, a 27-Fr Avalon Elite bi-caval dual lumen catheter (Avalon Laboratories, Rancho Dominguez, CA, USA) was percutaneously inserted into the right jugular vein under fluoroscopy. With the catheter fully inserted, fluoroscopy showed that the tip just reached the inferior vena cava. The first X-ray confirmed this correct position.
On the third day, X-ray showed that the ECMO cannula projected into the right atrium. Many attempts to reposition the cannula under fluoroscopic control failed to obtain a stable position. The team therefore had to accept the position of the tip in the right atrium.
We conclude that when the cannula is short in relation to patient anatomy, misplacement of the cannula can easily occur and this could have serious complications.
Conflicts of interest
None of the authors declare a conflict of interest. There was no financial support.
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Coronary angiogram showing compression of the right coronary artery by the ECMO catheter in the left anterior oblique view and perpendicularly, the right inferior oblique view (14 days after cannula insertion). (MP4 1,826 kb)
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