Faculty Collaboration Database

Adhered ECMO cannula in COVID-19 related severe acute respiratory failure. J Cardiothorac Surg 2022 Oct 08;17(1):263

Date

10/09/2022

Pubmed ID

36209244

Pubmed Central ID

PMC9547677

DOI

10.1186/s13019-022-02004-4

Scopus ID

2-s2.0-85139431277 (requires institutional sign-in at Scopus site)

Abstract

BACKGROUND: Crescent cannula adhesion in the setting of COVID-19 respiratory failure requiring extracorporeal membrane oxygenation (ECMO) support is a novel complication. The objective of this case presentation is to highlight this rare complication and to explore potential predisposing factors and our management strategies.

CASE PRESENTATION: We present the case of a 25 y.o. patient with COVID-19 respiratory failure requiring ECMO support for 16-days in which a 32 Fr crescent cannula became adherent to the SVC and proximal jugular vein. Attempts to remove the cannula at the bedside failed due to immobility of the cannula. Ultrasound of the right neck was unremarkable, so he was taken to the hybrid OR where both TEE and fluoroscopy were unrevealing. An upper sternotomy was performed, and the superior vena cava and proximal jugular vein were dissected revealing a 2 cm segment of the distal SVC and proximal jugular vein that was densely sclerosed and adherent to the cannula. The vessel was opened across the adherent area at the level of the innominate vein and the cannula was then able to be withdrawn. The patient suffered no ill effects and had an unremarkable recovery to discharge.

CONCLUSIONS: To date, there have been no reports of crescent cannula adhesion related complications. In patients with COVID-19 respiratory failure requiring ECMO, clinicians should be aware of widespread hypercoagulability and the potential of unprovoked, localized venous sclerosis and cannula adhesion. We report our technique of decannulation in the setting of cannula adhesion and hope that presentation will shed further light on this complication allowing clinicians to optimize patient care.

Author List

Kamalia MA, Carlson SF, Melamed J, Ubert A, Rossi PJ, Durham LA

Authors

Lucian A. Durham MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin
Peter J. Rossi MD Chief, Professor in the Surgery department at Medical College of Wisconsin
H Adam Ubert MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cannula
Extracorporeal Membrane Oxygenation
Humans
Male
Respiratory Insufficiency
Vena Cava, Superior