Double lumen bi-cava cannula for veno-venous extracorporeal membrane oxygenation as bridge to lung transplantation in non-intubated patient

Extracorporeal membrane oxygenation (ECMO) is used for refractory respiratory failure. Normally, ECM is implanted in intubated patients 35 a last resort. We report the case of a non-intubated patient who benefited from veno-venous (VV) ECMO. A 35-year old cystic fibrosis man presented a severe respiratory decompensation with refractory hypercapnia. We opted for an ECM() instead of mechanical ventilation (MV). We implanted a double lumen bi-cava cannula (DLC) (Avalon Elite (TM)) in the right jugular vein. Before ECM() implantation, the patient presented refractory respiratory failure (pH = 7.1, PaO2 = 83 mmHg, PaCO2 = 103 mmHg). We proposed that the patient be placed on the high emergency lung transplantation waiting list after failure to wean him from ECMO. This registration was effective 10 days after ECMO implantation. The patient was grafted the next day. Under ECMO, mean PaO2, PaCO2 and TCA were 80.6 +/- 14.2, 53.8 +/- 6.4 mmHg and 56.2 +/- 9.7 s, respectively. The patient could eat, drink, talk and practice chest physiotherapy. The evolution was uneventful under ECMO. Weaning from ECM was done in the operating theatre after transplantation. W ECM with DLC is safe and feasible in non-intubated patients. It avoids potential complications of MV, and allows respiratory assistance as bridge to transplantation.