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Intraoperative Transesophageal Echocardiography–Guided Placement of Bicaval Dual-Lumen Extracorporeal Membrane Oxygenation Cannula.

ABSTRACT: Highlights•The Avalon catheter can establish VV ECMO via the right internal jugular vein.•Proximal and distal inflow orifices should be positioned in the SVC and IVC.•The cannula is aimed toward the tricuspid valve to deliver blood through the valve.•TEE is used to guide cannula placement and evaluate final position and cannula flow.•Malposition of cannulas may cause complications (e.g., tissue injury, low ECMO flow).

SUBMITTER: Chacon MM

PROVIDER: S-EPMC6058248 | biostudies-other | 2017 Jun

REPOSITORIES: biostudies-other

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Project description:BACKGROUND:Intraoperative Extracorporeal membrane oxygenation (ECMO) is increasingly being applied as life-support for lung transplantation patients. However, factors associated with this procedure in lung transplantation patients have not yet been characterized. The aim of this study was to identify preoperative factors of intraoperative ECMO support during lung transplantation and to evaluated the outcome of lung transplantation patients supported with ECMO. METHODS:Patients underwent lung transplantation treated with and without ECMO in Guangzhou Institute of Respiratory Diseases between January 2015 to August 2018 were retrospectively reviewed. Patient demographics and clinical variables were collected and analyzed. Multivariate logistic regression was performed to identify factors independently associated with intraoperative extracorporeal membrane oxygenation support during lung transplantation. RESULTS:During the study period, 138 patients underwent lung transplantation at our institution, the mean LAS was (56.63?±?18.39) (range, 32.79 to 88.70). Fourty four patients were treated with veno-venous/veno-arterial ECMO. Among the patients, 32 patients wean successfully ECMO after operation, 12 patients remain ECMO after operation, and 32 patients (62.74%) survived to hospital discharge. In multiple analysis, the following factors were associated with intraoperative ECMO support: advanced age, high PAP before operation, duration of mechanical ventilation before operation, a higher APACHE II and primary diagnosis for transplantation. The overall survival rates at 1, 3, and 12?months were 90.91, 72.73, and 56.81% in the ECMO group, and 95.40, 82.76, and 73.56% in the non-ECMO group, respectively (log-rank P?=?0.081). Patients who underwent single lung transplant had a lower survival rates in ECMO group as compared with non-ECMO group at 1, 3, and 12?months (90.47% vs 98.25, 71.43% vs 84.21, and 52.38% vs 75.44%) (log-rank P =?0.048). CONCLUSIONS:The preoperative factors of intraoperative ECMO support during lung transplantation included age, high PAP before operation, preoperative mechanical ventilation, a higher APACHE II and primary diagnosis for transplantation based on multivariate analysis.

Dataset Information

Intraoperative Transesophageal Echocardiography–Guided Placement of Bicaval Dual-Lumen Extracorporeal Membrane Oxygenation Cannula.

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