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Management of a bi-caval dual lumen cannula clot obstruction after TEE guided diagnosis: a case report
BACKGROUND: Veno-venous extracorporeal membrane oxygenation is an established therapy for patients with refractory acute respiratory distress syndrome (ARDS). One complication related to the use of veno-venous extracorporeal membrane oxygenation is thrombosis despite proper anticoagulation. We repor...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9373698/ https://www.ncbi.nlm.nih.gov/pubmed/32173066 http://dx.doi.org/10.1016/j.bjane.2020.02.012 |
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author | Zamper, Raffael Pereira Cezar Bainbridge, Daniel Nagpal, Dave Fujii, Satoru |
author_facet | Zamper, Raffael Pereira Cezar Bainbridge, Daniel Nagpal, Dave Fujii, Satoru |
author_sort | Zamper, Raffael Pereira Cezar |
collection | PubMed |
description | BACKGROUND: Veno-venous extracorporeal membrane oxygenation is an established therapy for patients with refractory acute respiratory distress syndrome (ARDS). One complication related to the use of veno-venous extracorporeal membrane oxygenation is thrombosis despite proper anticoagulation. We report the diagnosis and management of a clot-obstruction in a single site cannula placed through the internal jugular vein, guided by transesophageal echocardiography. CASE REPORT: A 39 year-old male developed acute respiratory distress syndrome and hemodynamic instability after an episode of pulmonary aspiration in the ICU. Eight hours after placement of a single site veno-venous extracorporeal membrane oxygenation, suddenly the perfusionist noticed a reduction in flow. TEE showed a thrombus-like mass obstructing the inflow port in SVC and inflow at IVC was intact. After unsuccessful attempts to reposition the cannula, the team decided to insert additional femoral inflow cannula through the IVC. The single site catheter was then pulled out until its tip was positioned in the right atrium and all three ports of the catheter were switched to the infusion ports. After this, flows and oxygenation improved significantly. Unfortunately, despite all of the efforts, the patient died 2 days later. DISCUSSION: The diagnosis of veno-venous extracorporeal membrane oxygenation cannula obstruction is based on reduced inflow rates, hemodynamic instability and poor oxygenation of blood. TEE allows evaluation of the flows inside the cannula and in this case, an obstruction was found. The management presented points to the fact that in a situation of catheter obstruction caused by a clot, there is a feasible alternative to assure minimal interruption of the hemodynamic support offered by the veno-venous extracorporeal membrane oxygenation. |
format | Online Article Text |
id | pubmed-9373698 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-93736982022-08-15 Management of a bi-caval dual lumen cannula clot obstruction after TEE guided diagnosis: a case report Zamper, Raffael Pereira Cezar Bainbridge, Daniel Nagpal, Dave Fujii, Satoru Braz J Anesthesiol Case Reports BACKGROUND: Veno-venous extracorporeal membrane oxygenation is an established therapy for patients with refractory acute respiratory distress syndrome (ARDS). One complication related to the use of veno-venous extracorporeal membrane oxygenation is thrombosis despite proper anticoagulation. We report the diagnosis and management of a clot-obstruction in a single site cannula placed through the internal jugular vein, guided by transesophageal echocardiography. CASE REPORT: A 39 year-old male developed acute respiratory distress syndrome and hemodynamic instability after an episode of pulmonary aspiration in the ICU. Eight hours after placement of a single site veno-venous extracorporeal membrane oxygenation, suddenly the perfusionist noticed a reduction in flow. TEE showed a thrombus-like mass obstructing the inflow port in SVC and inflow at IVC was intact. After unsuccessful attempts to reposition the cannula, the team decided to insert additional femoral inflow cannula through the IVC. The single site catheter was then pulled out until its tip was positioned in the right atrium and all three ports of the catheter were switched to the infusion ports. After this, flows and oxygenation improved significantly. Unfortunately, despite all of the efforts, the patient died 2 days later. DISCUSSION: The diagnosis of veno-venous extracorporeal membrane oxygenation cannula obstruction is based on reduced inflow rates, hemodynamic instability and poor oxygenation of blood. TEE allows evaluation of the flows inside the cannula and in this case, an obstruction was found. The management presented points to the fact that in a situation of catheter obstruction caused by a clot, there is a feasible alternative to assure minimal interruption of the hemodynamic support offered by the veno-venous extracorporeal membrane oxygenation. Elsevier 2020-02-10 /pmc/articles/PMC9373698/ /pubmed/32173066 http://dx.doi.org/10.1016/j.bjane.2020.02.012 Text en © 2020 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Case Reports Zamper, Raffael Pereira Cezar Bainbridge, Daniel Nagpal, Dave Fujii, Satoru Management of a bi-caval dual lumen cannula clot obstruction after TEE guided diagnosis: a case report |
title | Management of a bi-caval dual lumen cannula clot obstruction after TEE guided diagnosis: a case report |
title_full | Management of a bi-caval dual lumen cannula clot obstruction after TEE guided diagnosis: a case report |
title_fullStr | Management of a bi-caval dual lumen cannula clot obstruction after TEE guided diagnosis: a case report |
title_full_unstemmed | Management of a bi-caval dual lumen cannula clot obstruction after TEE guided diagnosis: a case report |
title_short | Management of a bi-caval dual lumen cannula clot obstruction after TEE guided diagnosis: a case report |
title_sort | management of a bi-caval dual lumen cannula clot obstruction after tee guided diagnosis: a case report |
topic | Case Reports |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9373698/ https://www.ncbi.nlm.nih.gov/pubmed/32173066 http://dx.doi.org/10.1016/j.bjane.2020.02.012 |
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