Venovenous extracorporeal membrane oxygenation (VV ECMO) is used in cases of refractory respiratory failure, temporarily replacing function of the failing lungs. Use of VV ECMO is increasing along with a wider array of cannulas and devices available for use.1 Dual lumen cannulas have been developed as an alternative to the traditional use of two single lumen cannulas. Potential benefits include single access site and easier mobilization.2 The ProtekDuo right atrium (RA) to pulmonary artery (PA) dual lumen cannula was introduced in 2014 allowing percutaneous oxygenated right ventricular (RV) support (LivaNova, London, United Kingdom). However, in our experience, this cannula can be flow-limited by inadequate venous drainage requiring placement of an additional inflow cannula. We describe a series of four patients treated with ECMO for COVID-19–associated respiratory failure utilizing ProtekDuo cannula with an additional femoral inflow cannula complicated by ProtekDuo intracannula thrombus (Table 1). To our knowledge, this complication has not before been described in the medical literature. We discuss possible causes and need for further investigation.
Intracannula Thrombus Formation Associated With Dual Lumen ProtekDuo Cannula in Extracorporeal Membrane Oxygenation (ECMO)
Abstract
Extracorporeal membrane oxygenation (ECMO) is used in cases of severe respiratory failure refractory to medical management. Use of ECMO is increasing, along with new cannulation strategies including oxygenated right ventricular assist devices (oxy-RVADs). Multiple dual lumen cannulas are now available, which increase the potential for patient mobility and decrease the number of vascular access sites. However, dual lumen, single cannula flow can be limited by adequate inflow, requiring the need for an additional inflow cannula to meet patient demands. This cannula configuration may result in differential flows in the inflow and outflow limbs and altered flow dynamics, increasing the risk of intracannula thrombus. We describe a series of four patients treated with oxy-RVAD for COVID-19–associated respiratory failure complicated by dual lumen ProtekDuo intracannula thrombus.