Parallel Dual-Lumen Venovenous Extracorporeal Membrane Oxygenation Following Extracorporeal Cardiopulmonary Resuscitation.
Elliott Worku, Sridevi Shetty, Paul Forrest et al.
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Case in brief
The report describes two patients receiving extracorporeal cardiopulmonary resuscitation who developed severe differential hypoxemia while supported with peripheral venoarterial ECMO. To address the poorly oxygenated blood reaching the cerebral circulation, clinicians added parallel venovenous ECMO using a dual-lumen bicaval cannula. Arterial support was removed after 4 and 7 days, respectively, with patients initially transitioned to high-flow VV-ECMO. The authors present this configuration as an alternative to hybrid veno-arterial-venous ECMO for managing differential hypoxemia after ECPR.
What made this case unusual
Parallel VV-ECMO using a dual-lumen bicaval cannula was used alongside VA-ECMO after ECPR to salvage severe differential hypoxemia, rather than using the hybrid VAV-ECMO configuration discussed as an alternative.
Diagnostic / clinical pearl
After ECPR, differential hypoxemia during peripheral VA-ECMO can threaten cerebral oxygenation; parallel VV-ECMO with a dual-lumen bicaval cannula was used in these cases to address it.
Why it matters
The report describes a potential escalation option for severe differential hypoxemia after successful ECPR, while its evidence is limited to two cases.