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


1 Department of Cardiac Anesthesia, Institute of Heart and Lung Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India
2 Department of Anesthesia and Critical Care, Institute of Heart and Lung Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India
3 Department of Cardiac Sciences Thoracic Organ Transplants, Institute of Heart and Lung Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India

Correspondence Address:
P Hemamalini
No. 15, Sri Rajarajeshwari Nagar, 1st Main Road, Old Perungalathur, Chennai - 600 063, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_75_19

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Year : 2020  |  Volume : 23  |  Issue : 3  |  Page : 283-287

 

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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.






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1 Department of Cardiac Anesthesia, Institute of Heart and Lung Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India
2 Department of Anesthesia and Critical Care, Institute of Heart and Lung Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India
3 Department of Cardiac Sciences Thoracic Organ Transplants, Institute of Heart and Lung Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India

Correspondence Address:
P Hemamalini
No. 15, Sri Rajarajeshwari Nagar, 1st Main Road, Old Perungalathur, Chennai - 600 063, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_75_19

Rights and Permissions

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.






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