Skip to main content
SpringerLink
Log in

Overview of the bicaval dual lumen cannula

  • Review Article
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a form of extracorporeal life support that provides total gas exchange (CO2 and O2) within the central venous circulation. The bicaval dual lumen cannula (DLC) is an option for patients requiring respiratory support with VV-ECMO. The catheter is inserted via the internal jugular vein into the superior and inferior vena cava, drains blood into the ECMO circuit for gas exchange, and then returns arterialized blood to the right heart for circulation. The DLC facilitates physical therapy, ambulation, and early extubation. This chapter will review the uses, advantages, and unique complications of the DLC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Extracorporeal Life Support Organization (ELSO). General guidelines for all ECLS cases. August 2017. https://www.elso.org/Resources/Guidelines.aspx. Accessed June 12 2019.

  2. Makdisi G, Wang IW. Extra Corporeal Membrane Oxygenation (ECMO) review of a lifesaving technology. J Thorac Dis. 2015;7:E166–76.

    PubMed  PubMed Central  Google Scholar 

  3. Lorusso R, Alexander P, Rycus P, Barbaro R. The extracorporeal life support organization registry:update and perspectives. Ann Cardiothorac Surg. 2019;8:93–8.

    PubMed  PubMed Central  Google Scholar 

  4. ECMO. Registry of the Extracorporeal Life Support Organization (ELSO). Ann Arbor: Michigan; April, 2019.

    Google Scholar 

  5. Bartlett RH, Gazzaniga AB, Toomasian J, Coran AG, Roloff D, Rucker R. Extracorporeal membrane oxygenation (ECMO) in neonatal respiratory failure. 100 cases. Ann Surg. 1986;204:236–45.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Bartlett RH, Roloff DW, Cornell RG, Andrews AF, Dillon PW, Zwischenberger JB. Extracorporeal circulation in neonatal respiratory failure: a prospective randomized study. Pediatrics. 1985;76:479–87.

    CAS  PubMed  Google Scholar 

  7. O'Rourke PP, Crone RK, Vacanti JP, et al. Extracorporeal membrane oxygenation and conventional medical therapy in neonates with persistent pulmonary hypertension of the newborn: a prospective randomized study. Pediatrics. 1989;84:957–63.

    CAS  PubMed  Google Scholar 

  8. No authors listed. UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation. UK Collaborative ECMO Trail Group. Lancet. 1996;348:75-82.

  9. Anderson HL, Otsu T, Chapman RA, Barlett RH. Venovenous extracorporeal life support in neonates using a double lumen catheter. ASAIO Trans. 1989;35:650–3.

    PubMed  Google Scholar 

  10. Harvey C. Cannulation for Neonatal and Pediatric Extracorporeal Membrane Oxygenation for Cardiac Support. Front Pediatr. 2018;6:17.

    PubMed  PubMed Central  Google Scholar 

  11. Zwischenberger JB, Toomasian JM, Drake K, Andrews AF, Kolobow T, Bartlett RH. Total respiratory support with single cannula venovenous ECMO: double lumen continuous flow vs. single lumen tidal flow. Trans Am Soc Artif Intern Organs. 1985;31:610–5.

    CAS  PubMed  Google Scholar 

  12. Andrews AF, Zwischenberger JB, Cilley RE, Drake KL. Venovenous extracorporeal membrane oxygenation (ECMO) using a double-lumen cannula. Artif Organs. 1987;11:265–8.

    CAS  PubMed  Google Scholar 

  13. Otsu T, Merz SI, Hultquist KA, et al. Laboratory evaluation of a double lumen catheter for venovenous neonatal ECMO. ASAIO Trans. 1989;35:647–50.

    CAS  PubMed  Google Scholar 

  14. Anderson HL, Snedecor SM, Otsu T, Barlett RH. Multicenter comparison of conventional venoarterial access versus venovenous double-lumen catheter access in newborn infants undergoing extracorporeal membrane oxygenation. J Pediatr Surg. 1993;28:530–4.

    PubMed  Google Scholar 

  15. Delius R, Anderson H, Schumacher R, et al. Venovenous compares favorably with venoarterial access for extracorporeal membrane oxygenation in neonatal respiratory failure. J Thorac Cardiovasc Surg. 1993;106:329–38.

    CAS  PubMed  Google Scholar 

  16. Gauger PG, Hirschl RB, Delosh TN, Dechert RE, Tracy T, Bartlett RH. A matched pairs analysis of venoarterial and venovenous extracorporeal life support in neonatal respiratory failure. ASAIO J. 1995;41:M573–9.

    CAS  PubMed  Google Scholar 

  17. Zwischenberger JB, Nguyen TT, Upp JR, et al. Complications of neonatal extracorporeal membrane oxygenation. Collective experience from the extracorporeal life support organization. J Thorac Cardiovasc Surg. 1994;107:838–48.

    CAS  PubMed  Google Scholar 

  18. Wang D, Zhou X, Liu X, Sidor B, Lynch J, Zwischenberger JB. Wang-Zwische double lumen cannula-toward a percutaneous and ambulatory paracorporeal artificial lung. ASAIO J. 2008;54:606–11.

    PubMed  Google Scholar 

  19. Davies A, Jones D, Bailey M, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA. 2009;302:1888–95.

    CAS  PubMed  Google Scholar 

  20. Noah MA, Peek GJ, Finney SJ, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA. 2011;306:1659–68.

    CAS  PubMed  Google Scholar 

  21. Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): A multicentre randomised controlled trial. Lancet. 2009;374:1351–63.

    PubMed  Google Scholar 

  22. Bermudez CA, Rocha RV, Sappington PL, Toyoda Y, Murray HN, Boujoukos AJ. Initial experience with single cannulation for venovenous extracorporeal oxygenation in adults. Ann Thorac Surg. 2010;90:991–5.

    PubMed  Google Scholar 

  23. Javidfar J, Brodie D, Wang D, et al. Use of bicaval dual-lumen catheter for adult venovenous extracorporeal membrane oxygenation. Ann Thorac Surg. 2011;91:1763–8.

    PubMed  Google Scholar 

  24. Zamora IJ, Shekerdemian L, Fallon SC, et al. Outcomes comparing dual-lumen to multisite venovenous ECMO in the pediatric population: The extracorporeal life support registry experience. J Pediatr Surg. 2014;49:1452–7.

    PubMed  Google Scholar 

  25. Abrams D, Brodie D. Emerging indications for extracorporeal membrane oxygenation in adults with respiratory failure. Ann Am Thorac Soc. 2013;10:371–7.

    PubMed  Google Scholar 

  26. Taccone FS, Malfertheiner MV, Ferrari F, et al. Extracorporeal CO2 removal in critically ill patients: A systematic review. Minerva Anestesiol. 2017;83:762–72.

    PubMed  Google Scholar 

  27. Gattinoni L, Kolobow T, Agostoni A, et al. Clinical application of low frequency positive pressure ventilation with extracorporeal CO2 removal (LFPPV-ECCO2R) in treatment of adult respiratory distress syndrome (ARDS). Int J Artif Organs. 1979;2:282–3.

    CAS  PubMed  Google Scholar 

  28. Morris AH, Wallace CJ, Menlove RL, et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994;149:295–305.

    CAS  PubMed  Google Scholar 

  29. Abrams DC, Brenner K, Burkart KM, et al. Pilot study of extracorporeal carbon dioxide removal to facilitate extubation and ambulation in exacerbations of chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2013;10:307–14.

    CAS  PubMed  Google Scholar 

  30. Brenner K, Abrams DC, Agerstrand CL, Brodie D. Extracorporeal carbon dioxide removal for refractory status asthmaticus: experience in distinct exacerbation phenotypes. Perfusion. 2014;29:26–8.

    CAS  PubMed  Google Scholar 

  31. Schneider TM, Bence T, Brettner F. “Awake” ECCO2R superseded intubation in a near-fatal asthma attack. J Intensive Care. 2017;5:53.

    PubMed  PubMed Central  Google Scholar 

  32. Lynch W. ECLS Cannulation for adults with respiratory failure. In: Brogan T, editor. Extracorporeal life support: The ELSO red book. Ann Arbor: ELSO; 2017. p. 429–36.

    Google Scholar 

  33. Schmid C, Philipp A, Hilker M, et al. Venovenous extracorporeal membrane oxygenation for acute lung failure in adults. J Heart Lung Transplant. 2012;31:9–15.

    PubMed  Google Scholar 

  34. Goligher EC, Tomlinson G, Hajage D, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome and posterior probability of mortality benefit in a post hoc bayesian analysis of a randomized clinical trial. JAMA. 2018;320:2251–9.

    PubMed  Google Scholar 

  35. Fuehner T, Kuehn C, Hadem J, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med. 2012;185:763–8.

    PubMed  Google Scholar 

  36. Bacchetta M, Javidfar J, Sonett J, Kim H, Zwischenberger J, Wang D. Ease of conversion from venovenous extracorporeal membrane oxygenation to cardiopulmonary bypass and venoarterial extracorporeal membrane oxygenation with a bicaval dual lumen catheter. ASAIO J. 2011;57:283–5.

    PubMed  Google Scholar 

  37. Kohler K, Valchanov K, Nias G, Vuylsteke A. ECMO cannula review. Perfusion. 2013;28:114–24.

    CAS  PubMed  Google Scholar 

  38. Sorokin V, MacLaren G, Vidanapathirana PC, Delnoij T, Lorusso R. Choosing the appropriate configuration and cannulation strategies for extracorporeal membrane oxygenation: The potential dynamic process of organ support and importance of hybrid modes. Eur J Heart Fail. 2017;19:75–83.

    CAS  PubMed  Google Scholar 

  39. Zhao J, Wang D, Ballard-Croft C, et al. Hybrid extracorporeal membrane oxygenation using avalon elite double lumen Cannula ensures adequate heart/brain oxygen supply. Ann Thorac Surg. 2017;104:847–53.

    PubMed  Google Scholar 

  40. Biscotti M, Bacchetta M. The "sport model": extracorporeal membrane oxygenation using the subclavian artery. Ann Thorac Surg. 2014;98:1487–9.

    PubMed  Google Scholar 

  41. Brasseur A, Scolletta S, Lorusso R, Taccone FS. Hybrid extracorporeal membrane oxygenation. J Thorac Dis. 2018;10:S707–15.

    PubMed  PubMed Central  Google Scholar 

  42. Mazzeffi M, Kon Z, Menaker J, et al. Large dual-lumen extracorporeal membrane oxygenation cannulas are associated with more intracranial hemorrhage. ASAIO J. 2019. https://doi.org/10.1097/MAT.0000000000000917.

  43. O'Brien C, Monteagudo J, Schad C, Cheung E, Middlesworth W. Centrifugal pumps and hemolysis in pediatric extracorporeal membrane oxygenation (ECMO) patients: An analysis of Extracorporeal Life Support Organization (ELSO) registry data. J Pediatr Surg. 2017;52:975–8.

    PubMed  Google Scholar 

  44. Camboni D, Akay B, Sassalos P, et al. Use of venovenous extracorporeal membrane oxygenation and an atrial septostomy for pulmonary and right ventricular failure. Ann Thorac Surg. 2011;91:144–9.

    PubMed  Google Scholar 

  45. Javidfar J, Brodie D, Sonett J, Bacchetta M. Venovenous extracorporeal membrane oxygenation using a single cannula in patients with pulmonary hypertension and atrial septal defects. J Thorac Cardiovasc Surg. 2012;143:982–4.

    PubMed  Google Scholar 

  46. Kon ZN, Pasrija C, Shah A, Griffith BP, Garcia JP. Venovenous extracorporeal membrane oxygenation with atrial septostomy as a bridge to lung transplantation. Ann Thorac Surg. 2016;101:1166–9.

    PubMed  Google Scholar 

  47. Broman LM, Malfertheiner MV, Montisci A, Pappalardo F. Weaning from veno-venous extracorporeal membrane oxygenation: how I do it. J Thorac Dis. 2018;10:S692–7.

    PubMed  PubMed Central  Google Scholar 

  48. Tignanelli CJ, Weinberg A, Napolitano LM. Optimal methods to secure extracorporeal membrane oxygenation bicaval dual-lumen cannulae: What works? ASAIO J. 2019;65:628–30.

    PubMed  Google Scholar 

  49. Rubino A, Vuylsteke A, Jenkins DP, Fowles JA, Hockings L, Valchanov K. Direct complications of the Avalon bicaval dual-lumen cannula in respiratory extracorporeal membrane oxygenation (ECMO): Single-center experience. Int J Artif Organs. 2014;37:741–7.

    PubMed  Google Scholar 

  50. Subramanian S, Vafaeezadeh M, Parrish AR, McMullan DM. Comparison of wire-reinforced and non-wire-reinforced dual-lumen catheters for venovenous ECMO in neonates and infants. ASAIO J. 2013;59:81–5.

    PubMed  Google Scholar 

  51. Shaheen A, Tanaka D, Cavarocchi NC, Hirose H. Veno-Venous Extracorporeal Membrane Oxygenation (V V ECMO): Indications, preprocedural considerations, and technique. J Card Surg. 2016;31:248–52.

    PubMed  Google Scholar 

  52. Ngai CW, Ng PY, Sin WC. Bicaval dual lumen cannula in adult veno-venous extracorporeal membrane oxygenation—clinical pearls for safe cannulation. J Thorac Dis. 2018;10:S624–8.

    PubMed  PubMed Central  Google Scholar 

  53. Griffee MJ, Tonna JE, McKellar SH, Zimmerman JM. Echocardiographic guidance and troubleshooting for venovenous extracorporeal membrane oxygenation using the dual-lumen bicaval cannula. J Cardiothorac Vasc Anesth. 2018;32:370–8.

    PubMed  Google Scholar 

  54. Chimot L, Marqué S, Gros A, et al. Avalon© bicaval dual lumen cannula for venovenous extracorporeal membrane oxygenation: survey of cannula use in France. ASAIO J. 2013;59:157–61.

    PubMed  Google Scholar 

  55. Fallon SC, Shekerdemian LS, Olutoye OO, et al. Initial experience with single-vessel cannulation for venovenous extracorporeal membrane oxygenation in pediatric respiratory failure. Pediatr Crit Care Med. 2013;14:366–73.

    PubMed  PubMed Central  Google Scholar 

  56. Jarboe MD, Gadepalli SK, Church JT, et al. Avalon catheters in pediatric patients requiring ECMO: Placement and migration problems. J Pediatr Surg. 2018;53:159–62.

    Google Scholar 

  57. Kanji HD, Chouldechova A, Harvey C, O'dea E, Faulkner G, Peek G. Safety and outcomes of mobile ecmo using a bicaval dual-stage venous catheter. ASAIO J. 2017;63:351–5.

    PubMed  Google Scholar 

  58. Lorusso R, Gelsomino S, Parise O, et al. Neurologic injury in adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure: Findings from the extracorporeal life support organization database. Crit Care Med. 2017;45:1389–97.

    PubMed  Google Scholar 

  59. Heller A, Dollerschell J, Burk J, Haines H, Kozinn J. Safety of intensivist-led bedside decannulation of internal jugular bi-caval dual-lumen veno-venous extracorporeal membrane oxygenation cannulas and report of technique. Anaesthesiol Intensive Ther. 2016;48:211–4.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Kentucky, College of Medicine, Lexington, KY, USA

    Vanessa Marie Bazan & Evan Michael Taylor

  2. Graduate Medical Education, Division of Cardiothoracic Surgery, Lexington, KY, USA

    Tyler Michael Gunn

  3. Department of Surgery, Division of Cardiothoracic Surgery, Lexington, KY, USA

    Joseph Bertram Zwischenberger

Authors
  1. Vanessa Marie Bazan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Evan Michael Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tyler Michael Gunn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph Bertram Zwischenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph Bertram Zwischenberger.

Ethics declarations

Conflict of interest

Dr. Zwischenberger has the following to disclose: he receives royalties for a patent licensed to Avalon/Maquet for the Avalon Elite double lumen cannula, he is the recipient of grant funding from the NIH, he is a consultant on the Cytosorbents, Inc. Cardiac Advisory Board, and he is a partner in WZ-Biotech. Vanessa M. Bazan has nothing to disclose. Evan M. Taylor has nothing to disclose. Dr. Gunn has nothing to disclose.

Funding

No funding was received for this review article

Informed Consent

Not Required for a Review Article

Ethical Clearance

Not Required for a Review Article

Human and Animal Rights Statement

Not Required for a Review Article

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bazan, V.M., Taylor, E.M., Gunn, T.M. et al. Overview of the bicaval dual lumen cannula. Indian J Thorac Cardiovasc Surg 37 (Suppl 2), 232–240 (2021). https://doi.org/10.1007/s12055-020-00932-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-020-00932-1

Keywords

Search

Navigation