Dual lumen venopulmonary extracorporeal membrane oxygenation cannulation technique using the ProtekDuo

Treatment strategies for acute respiratory distress syndrome have dramatically improved in recent years. Nevertheless, despite optimization of ventilator parameters, mortality remains high. Venovenous extracorporeal membrane oxygenation (ECMO) allows the elimination of carbon dioxide and supplying the systemic circulation with oxygenated blood during protective ventilation of the lung. The ProtekDuo (LivaNova, London, United Kingdom) is a single-site, dual‐lumen cannula, available in 2 sizes (29 and 31 Fr), manufactured as a right ventricular assist device and/or for venopulmonary (VP) ECMO for adults. The proximal drainage lumen delivers venous blood to the centrifugal pump (inflow), which returns blood flow distally (outflow) to the main pulmonary artery, allowing the right ventricle to be bypassed. This design facilitates reduction of preload with decompression of the right side of the heart. Mechanical circulatory properties of the ProtekDuo may be used to support the right ventricle as a right ventricular assist device or combined with a membrane lung incorporated into the circuit for VP ECMO [1]. The right internal jugular vein (RIJV) is the main access site for placement of the ProtekDuo cannula. The left subclavian vein has been described in the literature; however, it should remain an alternative access point because it allows easier control of bleeding of the RIJV. The advancement of the cannula may be controlled by fluoroscopy, or in some cases, by transoesophageal echocardiography during remote ECMO cannulations with limited technical capacities.