Perfusion | 2021
Inferior vena cava surgical cannulation for infants needing veno-venous extracorporeal membrane oxygenation.
Abstract
INTRODUCTION\nFemoral cannulation for veno-venous extracorporeal membrane oxygenation is challenging in infants because of the diameter of the vein.\n\n\nCASE REPORT\nProlonged ECMO support (67\u2009days) was necessary for an 8-month-old (8\u2009kg) girl with acute respiratory distress syndrome that was caused by H1N1 influenza. After 30\u2009days on ECMO support and using a single 16\u2009Fr double-lumen cannula (internal jugular vein), a second cannula was necessary to ensure adequate flow. This second 12\u2009Fr single-lumen cannula was surgically placed through the right common iliac vein. An excellent flow profile was then achieved and ECMO continued successfully for 37 more days.\n\n\nDISCUSSION\nAs a lifesaving option, this double caval configuration successfully optimized the flow profile and oxygenation, outweighing the related risks.\n\n\nCONCLUSION\nIn small children, a surgical approach to the inferior vena cava can be considered safe, especially in those cases where there is a shortage of adequate cannulas, or when central venous access is difficult.