Malposition of Double Lumen Bicaval Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) cannula resulting in hepatic venous congestion

Introduction: Optimal positioning of double lumen bicaval canula for extracorporeal membrane oxygenation (ECMO) support used as a rescue measure in refractory hypoxaemia is essential to facilitate adequate oxygenation, prevent recirculation and avoid complications. Method: Echocardiography via transoesophageal or transthoracic windows can be used as guidance and as a surveillance technique to prevent cannula malposition. We describe a case of Double‐Lumen Bicaval VV ECMO cannula malposition leading to a massive retrograde hepatic venous flow. Conclusion: Rapid echocardiographic diagnosis was pivotal in preventing potentially fatal complications.