ID:163 FC-D03-5 Conversion from Peripheral to Central VV ECMO in a child with massive hemothorax: case report

Background: Venovenous extracorporeal membrane oxygenation (VV-ECMO) in children had no RCTs providing guidance on the care of ECLS. Conventionally, VV-ECMO cannulation is performed with a double-lumen cannula, which can lead to complications such as poor recirculation, insufficient flow, and cannula displacement. The bicaval cannula has gained popularity, which is absent in our setting. Clinical Course/Activities: A previously healthy 2-year-old Thai boy was diagnosed with severe Influenza A acute respiratory distress syndrome with bilateral pneumothorax, which could not be managed with conventional mechanical ventilator management. He was initiated on double cannulation VV-ECMO at the SVC and left common femoral vein using the Seldinger technique. On the sixth day after ECMO cannulation, the patient had more frequent episodes of desaturation and ECMO insufficiency flow, which persisted despite euvolemia, no active bleeding, no high abdominal pressure, proper position of the cannula, and recirculation. He was diagnosed with right ventricular dysfunction and Insufficient flow. On the seventh day after ECMO cannulation, he developed a massive hemothorax type 3. The CVT surgeon stopped bleeding from the chest wall and lung parenchyma and converted the peripheral VV-ECMO to RA-PA central ECMO cannulation to address insufficient ECMO flow at the cannula site, leading to desaturation. After the central cannulation was completed, the inadequate flow issue was resolved, and the patient was decannulated on the 20th day without any complication from the ECMO circuit. Discussion: In our country, we were working in a resource-limited setting with no bicaval cannula available. Double peripheral cannulations were initially chosen for this patient, but this case showed inadequate flow. Converting from peripheral VV-ECMO to RA-PA central cannulation would be a good option to resolve this complication. Conclusion: Ultimately, the decision to convert to RA-PA central cannulation proved successful and could be more effective in managing critical conditions, especially in pediatric patients