A patient with a percutaneously inserted cardiopulmonary bypass cannula into the right internal jugular vein, connected to an extracorporeal membrane oxygenation (ECMO) circuit using tape, was referred for transport to our ECMO center. We describe management, quality improvement, and lessons learned.

A 68-year-old patient with a body mass index of 35 had a percutaneous coronary intervention (PCI) with stenting for an anterior myocardial infarction. During the procedure, the patient suffered ventricular fibrillation (VF) cardiac arrest and was placed on venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support. This center without an established ECMO service cannulated the right internal jugular vein with a 27 Fr cardiopulmonary bypass drainage cannula and returned flow through a 17 Fr, 23 cm femoral arterial cannula. The 27 Fr cannula did not have a connector, therefore 1/2” tubing was used to push the end of the cannula into the tubing and bridge from the cannula to the 3/8” tubing of the circuit, followed by fixation with tape. After arrival of our referral centers ECMO specialist, the tape was removed and replaced with a zip tie [Figure 1]. In addition, elastic stretchable band of 3” width was wrapped around the head and cannula for transport fixation. The patient was transported to our ECMO center with the connection almost falling apart. After arrival, a 25 Fr, 55 cm multistage femoral drainage cannula was placed, the 27 Fr cannula with 1/2” tubing was removed [Figures 2 and 3], and the 3/8” tubing wet connected to the new cannula without any hemodynamic compromise. We wish to emphasize the high-risk profile of transporting this patient with inadequate circuitry connection. Inexperienced centers should seek help from their referral center in establishing protocols and acquisition of adequate materials, such as cannulas, tubing, and connectors to assure patients’ safety.