Image guided placement of extracorporeal life support through bi-caval dual lumen venovenous membrane oxygenation in an interventional radiology setting - Initial experience

Purpose: To report our initial results of venovenous ECMO placement of a novel bicaval dual lumen catheter in six consecutive patients with severe respiratory failure. Methos: The dual lumen catheters (Avalon elite, Avalon Laboratories, Rancho Dominguez, CA, USA; available in 13, 16, 19, 20, 23, 27, and 31 French) were inserted with ultrasound-guided puncture via the right internal jugular vein. The devices were placed with the proximal drainage inlet in the SVC, with the distal drainage inlet tip in the IVC, and with the return outlet in the right atrium under fluoroscopy. Results: All catheter placements (1 x 19, 1 x 23, 1 x 27 and 3 x 31 French) were performed successfully: after insertion, adequate flows and gas exchange were obtained in all patients. Median support time was 9.5 days (range 3-41). We did not observe any cannulation-related events, especially no cannula displacement, no cannula thrombosis, no necessary repositioning, and no device failure. Decannulation and extubation was attained in 4/6 (66.7%) patients. 2/6 (33.3%) patients died (on day 3 and on day 10) while still under ECMO because of disease progression not controllable by medical means undertaken. The overall survival and hospital discharge rate in our small sample volume was 66.7% (4/6 patients) Conclusions: Our initial results suggest that single cannulation dual lumen venovenous ECMO catheter placement can be performed successfully and safely in an Interventional Radiology setting. The technique reported is feasible, easy to use, and the outcome seems to be comparable to other performing implanting specialties.