Abstract Introduction Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an established rescue modality for patients with severe respiratory failure refractory to conventional ventilation, serving as a bridge to recovery or transplantation. The bi-caval dual-lumen cannula is traditionally placed via the right internal jugular vein to optimize drainage and reinfusion flows. However, congenital or acquired vascular anomalies may preclude standard access. We present a case highlighting the feasibility of left internal jugular vein cannulation with bi-caval dual-lumen ECMO in a patient with complex vascular anatomy. Case A 35-year-old man with a history of bronchopulmonary dysplasia, prolonged mechanical ventilation through age 7, left upper lobectomy, and chronic hypoxic respiratory failure, whose course was complicated by recurrent admissions for respiratory failure with recent expedited lung transplant evaluation, presented with worsening dyspnea. On admission, he was found to have severe respiratory acidosis, with an initial arterial blood gas of pH 7.15 and pCO2 158 mmHg. Despite maximum noninvasive therapies and eventual mechanical ventilation, he developed recurrent severe hypercapnia requiring VV-ECMO consideration as a bridge to transplantation. The patient’s vascular anatomy was complex due to prior right internal jugular vein ligation and right femoral vein cut-down in childhood, limiting traditional access sites. An initial attempt to establish left femoral venous drainage and left internal jugular venous return was unsuccessful due to resistance to wire advancement. Given these challenges, a left internal jugular bi-caval dual-lumen cannula was placed for ECMO support, allowing effective gas exchange and successful bridge to double lung transplantation. Discussion As more adults with congenital lung disease and complex vascular anatomy survive into adulthood, alternative ECMO cannulation strategies are increasingly needed. Bi-caval dual-lumen cannulas are typically inserted via the right internal jugular vein, though left-sided access has been described. In the 2012 series by Abrams et al. (1), successful left internal jugular insertion followed complications during right-sided attempts, but the indications for dual-lumen use or avoidance of femoral access were not clearly defined. In contrast, our patient’s congenital vascular anomalies precluded right internal jugular and bilateral femoral access, leaving the left internal jugular vein as the only viable option. This case highlights that such anatomic limitations may be increasingly encountered, and that left-sided bi-caval cannulation can provide effective support when conventional strategies are not feasible. Reference: Abrams D, Brodie D, Javidfar J, et al. Insertion of bicaval dual-lumen cannula via the left internal jugular vein for extracorporeal membrane oxygenation. ASAIO J. 2012;58:636-637. This abstract is funded by: None
Testa et al. (Fri,) studied this question.