Axillary vein as an alternative venous access site for VV-ECMO cannulation: a case report
Abstract Background Ultrasound-guided percutaneous axillary vein cannulation can reduce cannulation failure and mechanical complications, is as safe and effective as internal jugular vein cannulation, and is superior to subclavian vein cannulation using landmark technique. As far, reports of venoven...
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-024-02600-6 |
| _version_ | 1797259044373659648 |
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| author | Tao Pan Xiaoyang Zhou Jianneng Pan Bixin Chen Chang Xu Zhaojun Xu Pingping Dong Tingting Yu |
| author_facet | Tao Pan Xiaoyang Zhou Jianneng Pan Bixin Chen Chang Xu Zhaojun Xu Pingping Dong Tingting Yu |
| author_sort | Tao Pan |
| collection | DOAJ |
| description | Abstract Background Ultrasound-guided percutaneous axillary vein cannulation can reduce cannulation failure and mechanical complications, is as safe and effective as internal jugular vein cannulation, and is superior to subclavian vein cannulation using landmark technique. As far, reports of venovenous extracorporeal membrane oxygenation (VV-ECMO) with percutaneous axillary vein cannulation are rare. Case presentation A 64-year-old man presenting with dyspnea and chest tightness after aspirating sewage was admitted to the emergency department. Computed tomography (CT) showed diffuse exudation of both lungs and arterial blood gas analysis showed an oxygenation index of 86. He was diagnosed with aspiration pneumonia-induced acute respiratory distress syndrome (ARDS) and intubated for deteriorated oxygenation. Despite the combination therapy of protective mechanical ventilation and prone position, the patient’s oxygenation deteriorated further, accompanied with multiple organ dysfunction syndrome, which indicated the requirement of support with VV-ECMO. However, vascular ultrasound detected multiple thrombus within bilateral internal jugular veins. As an alternative, right axillary vein was chosen as the access site of return cannula. Subsequently, femoral-axillary VV-ECMO was successfully implemented under the ultrasound guidance, and the patient’s oxygenation was significantly improved. Unfortunately, the patient died of hyperkalemia-induced ventricular fibrillation after 36 h of VV-ECMO running. Despite the poor prognosis, the blood flow during ECMO run was stable, and we observed no bleeding complication, vascular injury, or venous return disorder. Conclusions Axillary vein is a feasible alternative access site of return cannula for VV-ECMO if internal jugular vein access were unavailable. |
| first_indexed | 2024-04-24T23:03:10Z |
| format | Article |
| id | doaj.art-ee09022a930640dd90279d19b6f40b69 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-04-24T23:03:10Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-ee09022a930640dd90279d19b6f40b692024-03-17T12:37:56ZengBMCJournal of Cardiothoracic Surgery1749-80902024-03-011911610.1186/s13019-024-02600-6Axillary vein as an alternative venous access site for VV-ECMO cannulation: a case reportTao Pan0Xiaoyang Zhou1Jianneng Pan2Bixin Chen3Chang Xu4Zhaojun Xu5Pingping Dong6Tingting Yu7Department of Intensive Care MedicineDepartment of Intensive Care MedicineDepartment of Intensive Care MedicineDepartment of Intensive Care MedicineDepartment of Intensive Care MedicineDepartment of Intensive Care MedicineBaihe Street Community Health Services of Yinzhou DistrictDepartment of OphthalmologyAbstract Background Ultrasound-guided percutaneous axillary vein cannulation can reduce cannulation failure and mechanical complications, is as safe and effective as internal jugular vein cannulation, and is superior to subclavian vein cannulation using landmark technique. As far, reports of venovenous extracorporeal membrane oxygenation (VV-ECMO) with percutaneous axillary vein cannulation are rare. Case presentation A 64-year-old man presenting with dyspnea and chest tightness after aspirating sewage was admitted to the emergency department. Computed tomography (CT) showed diffuse exudation of both lungs and arterial blood gas analysis showed an oxygenation index of 86. He was diagnosed with aspiration pneumonia-induced acute respiratory distress syndrome (ARDS) and intubated for deteriorated oxygenation. Despite the combination therapy of protective mechanical ventilation and prone position, the patient’s oxygenation deteriorated further, accompanied with multiple organ dysfunction syndrome, which indicated the requirement of support with VV-ECMO. However, vascular ultrasound detected multiple thrombus within bilateral internal jugular veins. As an alternative, right axillary vein was chosen as the access site of return cannula. Subsequently, femoral-axillary VV-ECMO was successfully implemented under the ultrasound guidance, and the patient’s oxygenation was significantly improved. Unfortunately, the patient died of hyperkalemia-induced ventricular fibrillation after 36 h of VV-ECMO running. Despite the poor prognosis, the blood flow during ECMO run was stable, and we observed no bleeding complication, vascular injury, or venous return disorder. Conclusions Axillary vein is a feasible alternative access site of return cannula for VV-ECMO if internal jugular vein access were unavailable.https://doi.org/10.1186/s13019-024-02600-6Venovenous extracorporeal membrane oxygenationVein thrombosisReturn cannulaUltrasound-guided |
| spellingShingle | Tao Pan Xiaoyang Zhou Jianneng Pan Bixin Chen Chang Xu Zhaojun Xu Pingping Dong Tingting Yu Axillary vein as an alternative venous access site for VV-ECMO cannulation: a case report Journal of Cardiothoracic Surgery Venovenous extracorporeal membrane oxygenation Vein thrombosis Return cannula Ultrasound-guided |
| title | Axillary vein as an alternative venous access site for VV-ECMO cannulation: a case report |
| title_full | Axillary vein as an alternative venous access site for VV-ECMO cannulation: a case report |
| title_fullStr | Axillary vein as an alternative venous access site for VV-ECMO cannulation: a case report |
| title_full_unstemmed | Axillary vein as an alternative venous access site for VV-ECMO cannulation: a case report |
| title_short | Axillary vein as an alternative venous access site for VV-ECMO cannulation: a case report |
| title_sort | axillary vein as an alternative venous access site for vv ecmo cannulation a case report |
| topic | Venovenous extracorporeal membrane oxygenation Vein thrombosis Return cannula Ultrasound-guided |
| url | https://doi.org/10.1186/s13019-024-02600-6 |
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