Clinical application of dual-lumen cannulas in venovenous extracorporeal membrane oxygenation (VV-ECMO)

Venovenous extracorporeal membrane oxygenation (VV-ECMO) is an important life-support modality for patients with severe acute respiratory distress syndrome (ARDS) and other forms of refractory respiratory failure. Conventional two-site VV-ECMO cannulation is rapid and widely available, but it may be limited by recirculation, groin-related access complications, and barriers to mobilization. Bicaval dual-lumen cannulas (DLCs), most commonly inserted through the right internal jugular vein, drain venous blood from the superior and inferior venae cavae and return oxygenated blood through a right-atrial port directed toward the tricuspid valve. When accurately positioned, this configuration can improve circuit efficiency by reducing recirculation and may facilitate nursing care, prone positioning, extubation, and rehabilitation. However, these are primarily technical and physiologic advantages. The current evidence base remains largely observational and registry-based, and no definitive survival or major adverse-event advantage over conventional two-site VV-ECMO cannulation has been demonstrated. This review focuses strictly on bicaval and right-atrial DLCs used for VV-ECMO, summarizing device characteristics, cannulation and imaging strategies, complications, post-cannulation management, and evidence gaps.