PMID- 30250343
OWN - NLM
STAT- MEDLINE
DCOM- 20190117
LR  - 20190301
IS  - 0022-1058 (Print)
IS  - 0022-1058 (Linking)
VI  - 50
IP  - 3
DP  - 2018 Sep
TI  - Malposition of the Extracorporeal Membrane Oxygenation Venous Cannula in an 
      Accessory Hepatic Vein.
PG  - 167-169
AB  - We report a case of a refractory cardiogenic shock secondary to myocardial 
      infarction in a 70-year-old patient requiring femoral venoarterial extracorporeal 
      membrane oxygenation (VA-ECMO). At initial transesophageal echocardiography, the 
      venous cannula tip was seen in the inferior vena cava (IVC), but not in right 
      atrium. On day 8, ultrasonic examination identified that the end of the venous 
      cannula was in the hepatic vein (HV). Despite such malposition, no disturbance in 
      extracorporeal membrane oxygenation (ECMO) venous return was observed. Moving or 
      replacing the cannula was considered a high-risk maneuver potentially resulting 
      in hepatic laceration with hemoperitoneum. Because of adequate venous drainage, 
      allowing sufficient blood flow, venous cannula repositioning was delayed until 
      day 10, when a ventricular defect was repaired and ECMO was weaned off. At the 
      time of VA-ECMO implantation, the venous cannula has to be positioned in the 
      right atrium using real time echo monitoring. Visualization of the guide wire in 
      the IVC but not in the right atrium is insufficient to ensure appropriate venous 
      cannula positioning. Indeed, either accidental catheterization or cannula 
      migration into the HV is possible during ECMO. Health care professionals dealing 
      with ECMO have to be aware of this possible malposition, to correct it and 
      prevent insufficient venous drainage or traumatic complications.
FAU - Winiszewski, Hadrien
AU  - Winiszewski H
AD  - Medical Intensive Care Unit.
FAU - Perrotti, Andrea
AU  - Perrotti A
AD  - Cardiac Surgery Unit, University Hospital, Besancon, France.
AD  - Research Unit EA 3920 and SFR FED 4234, University of Franche Comte, Besancon, 
      France.
FAU - Chocron, Sidney
AU  - Chocron S
AD  - Cardiac Surgery Unit, University Hospital, Besancon, France.
AD  - Research Unit EA 3920 and SFR FED 4234, University of Franche Comte, Besancon, 
      France.
FAU - Capellier, Gilles
AU  - Capellier G
AD  - Medical Intensive Care Unit.
AD  - Department of Epidemiology and Preventive Medicine, School of Public Health and 
      Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, 
      Australia; and.
AD  - Research Unit EA 3920 and SFR FED 4234, University of Franche Comte, Besancon, 
      France.
FAU - Piton, Gael
AU  - Piton G
AD  - Medical Intensive Care Unit.
AD  - Research Unit EA 3920 and SFR FED 4234, University of Franche Comte, Besancon, 
      France.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - France
TA  - J Extra Corpor Technol
JT  - The journal of extra-corporeal technology
JID - 0267637
MH  - Aged
MH  - Catheters/*adverse effects
MH  - Extracorporeal Membrane Oxygenation/*adverse effects/instrumentation
MH  - Fatal Outcome
MH  - Hepatic Veins/diagnostic imaging/injuries/surgery
MH  - Humans
MH  - Male
MH  - Myocardial Infarction/surgery
MH  - *Prosthesis Failure
MH  - Shock, Cardiogenic/*etiology
PMC - PMC6146273
OTO - NOTNLM
OT  - echocardiography
OT  - extracorporeal membrane oxygenation
OT  - shock
EDAT- 2018/09/27 06:00
MHDA- 2019/01/18 06:00
PMCR- 2019/03/01
CRDT- 2018/09/26 06:00
PHST- 2017/08/08 00:00 [received]
PHST- 2018/04/06 00:00 [accepted]
PHST- 2018/09/26 06:00 [entrez]
PHST- 2018/09/27 06:00 [pubmed]
PHST- 2019/01/18 06:00 [medline]
PHST- 2019/03/01 00:00 [pmc-release]
AID - 1700035 [pii]
PST - ppublish
SO  - J Extra Corpor Technol. 2018 Sep;50(3):167-169.