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Case Reports: Learning from unexpected outcome (positive or negative)
Bicaval dual lumen cannula placement using transthoracic echocardiography in COVID-19 scenario: pearls and pitfalls
  1. Ngoc Minh Le1,
  2. Uyen The Dang2,
  3. Ha Viet Vu3 and
  4. Hieu Lan Nguyen1
  1. 1Cardiovascular Center, Hanoi Medical University, Hanoi, Viet Nam
  2. 2Department of Cardiovascular Anaesthesia, Hue Central Hospital, Hue, Thua Thien Hue, Viet Nam
  3. 3Department of Emergency and Intensive Care, Hanoi Medical University, Hanoi, Viet Nam
  1. Correspondence to Dr Ngoc Minh Le; ngocmedecine{at}gmail.com

Abstract

A woman in her 50s who had been diagnosed with COVID-19 developed deep vein thrombosis in the left femoral vein extending into inferior vena cava (IVC). An IVC filter was placed to prevent fatal pulmonary embolism. Her respiratory failure subsequently deteriorated despite optimal mechanical ventilation and required venovenous extracorporeal membrane oxygenation (VV-ECMO) as a rescue therapy. Femoro-jugular VV-ECMO configuration was not suitable due to the IVC filter, hence a single-site venous cannulation using bicaval dual lumen (AvalonElite) cannula was selected. Placement of the Avalon cannula conventionally requires guidance by fluoroscopy or transoesophageal echocardiography, which were not feasible in COVID-19 patients. Hence, transthoracic echocardiography guidance was chosen. Guidewire looping into the right ventricle might lead to cannula malposition and imminent right ventricular rupture, but these could be detected by ‘bending’ sign. Transthoracic echocardiography could be a feasible guidance method for Avalon cannulation, nonetheless a thorough protocol should be followed to avoid cannula malposition during the procedure.

  • COVID-19
  • Adult intensive care

https://doi.org/10.1136/bcr-2022-249195

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    Footnotes

    • Contributors NML was the echocardiographer during procedure, conceived the work, wrote the initial manuscript and drew all illustrations in the article. UTD and HVV were part of the intervention team as well as responsible for critical care. NLH was the chief interventionist and reviewed the final manuscript. All authors contributed to the article and approved the submitted version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.