Pre-emptive veno-venous ECMO in advanced tracheal malignancy prior to tracheal stenting

2021 ◽  
Vol 14 (8) ◽  
pp. e243596
Author(s):  
Mohammad Salman Siddiqi ◽  
Adil H Al Kindi ◽  
Ahmed Fahmy Mandisha ◽  
Rashid Al Sukaiti
Keyword(s):  
Carbon Dioxide ◽  
Extracorporeal Membrane Oxygenation ◽  
Airway Obstruction ◽  
Jugular Vein ◽  
Femoral Vein ◽  
Ventilatory Support ◽  
Successful Management ◽  
Flexible Bronchoscope ◽  
Carbon Dioxide Levels ◽  
Vv Ecmo

Extracorporeal membrane oxygenation (ECMO) is helpful in providing ventilatory support when other conventional methods of ventilation fail. We report a case of successful management of advanced tracheal malignancy with impeding airway obstruction where veno-venous ECMO (VV-ECMO) was instituted prior to performing critical endotracheal procedure. After securing the VV-ECMO through right jugular vein and left femoral vein under local anaesthesia, the tracheal stent placement was conducted under flexible bronchoscope and fluoroscope control. Oxygenation and carbon dioxide levels were maintained by the ECMO. VV-ECMO is a useful adjunct in the management of subglottic difficult airway obstruction due to complex tracheal pathology where conventional ventilation may not be possible or adequate.

Safely repositioning dual-lumen ECMO cannulas with a transfemoral lasso snare

Perfusion ◽  
2020 ◽  
pp. 026765912096903
Author(s):  
Erika R O’Neil ◽  
Ryan D Coleman ◽  
Adam M Vogel ◽  
Corey A Chartan ◽  
Kamlesh U Kukreja
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Real Time ◽  
Internal Jugular Vein ◽  
Pediatric Patients ◽  
Jugular Vein ◽  
Limb Ischemia ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
The Right ◽  
Fluoroscopy Guidance ◽  
Vv Ecmo

Introduction: Dual-lumen cannulas were designed to provide venovenous extracorporeal membrane oxygenation (VV ECMO) with single-vessel access. Anatomic and size considerations may make appropriate placement challenging in children. Dual-lumen cannulas are repositioned in 20–69% of pediatric patients, which can be difficult without transient discontinuation of ECMO support. Methods: We repositioned three dual-lumen ECMO cannulas introduced via the right internal jugular vein using a transfemoral snare technique under real-time ultrasound and fluoroscopy. Results: Two of three patients were supported on VV ECMO and one on veno-veno-arterial (VV-A) ECMO. Two of the three patients had their dual-lumen cannula repositioned under ultrasound and fluoroscopy guidance and one was repositioned just with ultrasound. No patient experienced a complication from the transfemoral snare technique such as femoral hematoma, hemorrhage or limb ischemia. Conclusion: We describe three patients who successfully had dual-lumen cannulas repositioned without cessation of ECMO using a transfemoral “lasso” technique.

Veno-Right Ventricle Bypass as a Lung Support System during Pulmonary Surgery without Ventilation

1997 ◽  
Vol 20 (10) ◽  
pp. 557-561 ◽  
Author(s):  
K. Horita ◽  
Z.L. Cao ◽  
T. Itoh
Keyword(s):  
Right Ventricle ◽  
Jugular Vein ◽  
Superior Vena ◽  
Femoral Vein ◽  
Ventilatory Support ◽  
Vena Cava ◽  
Venous Drainage ◽  
Pulmonary Surgery ◽  
Native Lung ◽  
The Right

A special lung support technique is required during carina! or tracheal surgery. Veno venous extracorporeal membrane oxygenation (ECMO) has become an accepted techinique for temporary lung support. Therefore, the purpose of our experiments was to evaluate the effect of veno venous ECMO (veno-right ventricle bypass) without ventilatory support. In five mongrel dogs, two venous drainage cannula were inserted into the superior vena cava through the right jugular vein and the inferior vena cava through the right femoral vein. In addition, a venous return cannula was inserted into the right ventricle (RV) through the right jugular vein. The veno-right ventricle (veno-RV) bypass system was composed of a centrifugal pump and membrane oxygenator; pump flow was maintained at 88 ± 14 ml/kg/min. Excellent hemodynamics and good oxygenation were obtained. On the basis of these results, we conclude that veno-RV bypass may be used as lung support during pulmonary surgery even though the native lung is not ventilated during the veno-RV bypass procedure.

scholarly journals CRITICAL CARE ECHO ROUNDS: Extracorporeal membrane oxygenation

2015 ◽  
Vol 2 (2) ◽  
pp. D1-D11 ◽  
Author(s):  
Kelly Victor ◽  
Nicholas A Barrett ◽  
Stuart Gillon ◽  
Abigail Gowland ◽  
Christopher I S Meadows ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Ventilatory Support ◽  
Ecmo Support ◽  
Respiratory Physiology ◽  
Organ Support ◽  
Septic Cardiomyopathy ◽  
Significant Past Medical History ◽  
Membrane Oxygenation ◽  
Vv Ecmo

Extracorporeal membrane oxygenation (ECMO) is an advanced form of organ support indicated in selected cases of severe cardiovascular and respiratory failure. Echocardiography is an invaluable diagnostic and monitoring tool in all aspects of ECMO support. The unique nature of ECMO, and its distinct effects upon cardio-respiratory physiology, requires the echocardiographer to have a sound understanding of the technology and its interaction with the patient. In this article, we introduce the key concepts underpinning commonly used modes of ECMO and discuss the role of echocardiography.CaseA 38-year-old lady, with no significant past medical history, was admitted to her local hospital with group A Streptococcal pneumonia. Rapidly progressive respiratory failure ensued and, despite intubation and maximal ventilatory support, adequate oxygenation proved impossible. She was attended by the regional severe respiratory failure service who established her on veno-venous (VV)-ECMO for respiratory support. Systemic oxygenation improved; however, significant cardiovascular compromise was encountered and echocardiography demonstrated a severe septic cardiomyopathy (ejection fraction <15%, aortic velocity time integral 5.9 cm and mitral regurgitation dP/dt 672 mmHg/s). Her ECMO support was consequently converted to a veno-veno-arterial configuration, thus providing additional haemodynamic support. As the sepsis resolved, arterial ECMO support was weaned under echocardiographic guidance; subsequent resolution of intrinsic respiratory function allowed the weaning of VV-ECMO support. The patient was liberated from ECMO 7 days after hospital admission.

scholarly journals Superior vena cava syndrome during veno-venous extracorporeal membrane oxygenation for COVID-19

Perfusion ◽  
2021 ◽  
pp. 026765912098797
Author(s):  
Rafal Kopanczyk ◽  
Omar H Al-Qudsi ◽  
Asvin M Ganapathi ◽  
Bethany R Potere ◽  
Paul S Pagel
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Internal Jugular Vein ◽  
Superior Vena Cava ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Membrane Oxygenation ◽  
Svc Syndrome ◽  
The Right ◽  
Vv Ecmo

Superior vena cava (SVC) syndrome is typically associated with malignant tumors obstructing the SVC, but as many as 40% of cases have other etiologies. SVC obstruction was previously described during veno-venous extracorporeal membrane oxygenation therapy (VV ECMO) in children. In this report, we describe a woman with adult respiratory distress syndrome resulting from infection with coronavirus-19 who developed SVC syndrome during VV ECMO. A dual-lumen ECMO cannula was inserted in the right internal jugular vein, but insufficient ECMO circuit flow, upper body edema, and signs of hypovolemic shock were observed. This clinical picture resolved when the right internal jugular vein was decannulated in favor of bilateral femoral venous cannulae. Our report demonstrates that timely recognition of clinical signs and symptoms led to the appropriate diagnosis of an uncommon ECMO complication.

Thrombosis of the Right Internal Jugular Vein is Not a Contraindication to Ambulatory Veno-Venous Extracorporeal Membrane Oxygenation with a Bicaval Dual-Lumen, Single Cannula System

2016 ◽  
Vol 19 (6) ◽  
pp. 282 ◽  
Author(s):  
Anthony Kronfli ◽  
Chetan Pasrija ◽  
Aakash Shah ◽  
Mehrdad Ghoreishi ◽  
Jose P Garcia ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Distress Syndrome ◽  
Ventilatory Support ◽  
Mechanical Ventilatory Support ◽  
Membrane Oxygenation ◽  
The Right ◽  
Hispanic Male ◽  
Cannula Placement ◽  
Vv Ecmo

Background: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an ever-emerging method of managing respiratory failure in patients who are refractory to conventional mechanical ventilatory support. An increasingly common method of cannulation involves placement of a bicaval dual-lumen, single cannula via the right internal jugular (IJ) vein. Thrombus in this vein has been considered a contraindication for cannula placement. Case report: A 45-year-old Hispanic male presented with bleomycin-induced respiratory failure resulting in acute respiratory distress syndrome (ARDS). Ambulatory VV-ECMO support was initiated, and during surgical cannula placement an occlusive thrombus was noted in the right IJ vein. A tract was dilated and the cannula was placed without any thromboembolic complications.Conclusion: This case demonstrates that cannulation for ambulatory VV-ECMO in the setting of an occlusive IJ thrombus can be safe and feasible.

scholarly journals Full recovery from severe SARS-CoV-2 infection after requiring extracorporeal membrane oxygenation and continuous hemodiafiltration

2020 ◽  
Author(s):  
Takafusa Yoshioka ◽  
Hiroshi Koganemaru ◽  
Tomohiro Murata ◽  
Akiko Mano ◽  
Kazuma Date ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Anticoagulation Therapy ◽  
Ventilatory Support ◽  
Fluid Secretion ◽  
Timely Manner ◽  
Continuous Hemodiafiltration ◽  
Neurological Sequelae ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Vv Ecmo

Abstract We report two cases of severe SARS-CoV-2 infection successfully treated with venovenous extracorporeal membrane oxygenation (VV-ECMO) and continuous hemodiafiltration (CHDF). ECMO was indicated despite immediate anti-viral and anticoagulation therapy with maximal ventilatory support. Meticulous bronchoscopic drainage was necessary during treatment by ECMO due to copious fluid secretion. Renal replacement therapy with continuous hemodiafiltration was also required for both cases due to ongoing renal dysfunction. However, both patients recovered fully without any disability or neurological sequelae. VV-ECMO is a vital tool to maintain appropriate gas exchange for severe SARS-CoV-2 infection to facilitate functional recovery. Because subsequent renal impairment is common in such severe cases, hemodiafiltration undertaken in a timely manner may be necessary. Controlling secondary bacterial infection is also key for lung recovery, as it may otherwise compromise the chance to wean patients off ECMO.

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