Transesophageal Echocardiography Compared to Fluoroscopy for Avalon Bicaval Dual-Lumen Cannula Positioning for Venovenous ECMO

The Avalon elite bicaval dual-lumen cannula for single site VenoVenous Extracorporeal Membrane Oxygenation (VV ECMO) offers several advantages. Correct placement of the Avalon cannula is safe using image guidance and needs either fluoroscopy or Transesophageal echocardiography (TEE). We assessed our...

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Bibliographic Details
Published in:Annals of cardiac anaesthesia 2020-07, Vol.23 (3), p.283-287
Main Authors: Hemamalini, P, Dutta, Prabhat, Attawar, Sandeep
Format: Article
Language:English
Subjects:
avalon elite bicaval dual-lumen cannula
Cardiovascular disease
Comparative analysis
Contraindications
Contrast agents
Echocardiography
Extracorporeal membrane oxygenation
fluoroscopy
Medical research
Original
Patient safety
Thrombosis
transesophageal echocardiography
Transplants & implants
Ultrasonic imaging
Veins & arteries
venovenous extracorporeal membrane oxygenation
Visualization
Wire
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Summary:The Avalon elite bicaval dual-lumen cannula for single site VenoVenous Extracorporeal Membrane Oxygenation (VV ECMO) offers several advantages. Correct placement of the Avalon cannula is safe using image guidance and needs either fluoroscopy or Transesophageal echocardiography (TEE). We assessed our institutional ECMO performance, cannulation related complications, instances of cannula malposition among patients cannulated using the two imaging modalities. We reviewed all patients who had Avalon cannula placement for VV ECMO at our institute. Ten patients were included in the study. Patients were cannulated using either fluoroscopy (Group A, n = 5) or TEE (Group B, n = 5). Data included patient demographics, diagnosis, evidence of cannula malposition, ECMO performance, cannulation related complications. The primary outcomes ease of cannulation; cannula malposition and the need for repositioning were compared between the two groups. Visualisation of guidewire, Avalon cannula and the average number of attempts to cannulate were similar (P > 0.05) between the two groups. Four patients cannulated using fluoroscopy had low flows whereas none of the patients cannulated using TEE had flow problems which was statistically significant (P = 0.024). Four cannulas (80%) placed under fluoroscopy required repositioning whereas one cannula (20%) placed under TEE needed repositioning. This difference was not statistically significant though (P = 0.099). TEE is the ideal imaging modality to guide Avalon elite cannula placement for VV ECMO.
ISSN:0971-9784
0974-5181
DOI:10.4103/aca.ACA_75_19