Anna Prishchepova, MD
Mercy Hospital Saint Louis
Saint Louis, MO
Disclosure information not submitted.
Vinaya Sermadevi, MD
Staff Physician; Adjunct Assistant Professor, SLU School of Medicine
Mercy Hospital Saint Louis, United States
Disclosure information not submitted.
Chakradhar Venkata, MD
Staff Physician; Adjunct Associate Professor, SLU School of Medicine
Mercy Heart and Vascular Hospital St. Louis, United States
Disclosure information not submitted.
Michael Plisco, MD
Pulmonology, Critical Care Medicine
Mercy Hospital Saint Louis, United States
Disclosure information not submitted.
Title: Successful Venovenous ECMO Cannulation in Two Patients with Existing IVC Filters
Case Report Body:
Introduction: Venovenous extracorporeal membrane oxygenation (VV ECMO) is a therapeutic option available for patients with severe respiratory failure refractory to medical management. A common two-vessel VV ECMO cannulation configuration consists of a femoral venous drainage cannula and an internal jugular venous return cannula. According to previous case reports, patients with existing IVC filters are at risk of filter dislodgement during and after femoral cannula placement. The following cases describe patients with pre-existing IVC filters who successfully underwent the femoral approach cannulation.
Description: A 46-year-old woman with a remote history of IVC filter placement for venous thromboembolism was admitted with acute respiratory distress syndrome due to bacterial pneumonia requiring mechanical ventilation. Despite lung protective ventilation, neuromuscular blockade, prone positioning and epoprostenol, the patient worsened and required VV ECMO. At the time of cannulation there was concern for IVF filter migration. Patient underwent fluoroscopy-guided cannula implantation and explantation, without any change in IVC filter position. She had a successful VV ECMO course and was eventually discharged to a long-term care facility.
A 52-year-old man with newly diagnosed left upper lobe non-small cell lung cancer complicated by bilateral lower extremity deep vein thromboses underwent IVC filter placement and subsequent left pneumonectomy with curative intent. His post-operative course was complicated by refractory respiratory failure due to bronchial stump dehiscence and right lung aspiration pneumonia requiring emergent bedside VV ECMO cannulation without fluoroscopy. Abdominal radiographs done prior to and after ECMO cannulation confirmed stable position of the IVC filter. ECMO support was provided for two weeks without any flow disruptions. Due to lack of return of native lung function, VV ECMO was stopped and patient was transitioned to comfort measures.
Discussion: In patients who require VV ECMO in the presence of existing IVC filters, there are some alternate options to the femoral vein drainage cannula such as a dual-lumen internal jugular approach. However, these cases illustrate that a femoral drainage cannula can be placed safely through an IVC filter without its migration or ECMO flow disruptions.