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Management of a bi-caval dual lumen cannula clot obstruction after TEE guided diagnosis: a case report / Conduta em obstrução por coágulo em cânula de duplo lúmen bicaval após diagnóstico guiado por ETE: relato de caso
Department of Anesthesiology and Perioperative MedicineZamper, Raffael Pereira Cezar; Department of Anesthesiology and Perioperative MedicineBainbridge, Daniel; Department of SurgeryNagpal, Dave; Department of Anesthesiology and Perioperative MedicineFujii, Satoru.
  • Department of Anesthesiology and Perioperative MedicineZamper, Raffael Pereira Cezar; Western University. University Hospital - London Health Sciences Centre. Department of Anesthesiology and Perioperative MedicineZamper, Raffael Pereira Cezar. London. CA
  • Department of Anesthesiology and Perioperative MedicineBainbridge, Daniel; Western University. University Hospital - London Health Sciences Centre. Department of Anesthesiology and Perioperative MedicineBainbridge, Daniel. London. CA
  • Department of SurgeryNagpal, Dave; University of Western Ontario. Critical Care and Cardiac Surgery. Department of SurgeryNagpal, Dave. London. CA
  • Department of Anesthesiology and Perioperative MedicineFujii, Satoru; University Hospital - London Health Sciences Centre. Western University. Department of Anesthesiology and Perioperative MedicineFujii, Satoru. London. CA
Rev. bras. anestesiol ; 70(1): 55-58, Jan.-Feb. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137135
ABSTRACT
Abstract

Background:

Veno-venous extracorporeal membrane oxygenation is an established therapy for patients with refractory acute respiratory distress syndrome (ARDS). One complication related to the use of veno-venous extracorporeal membrane oxygenation is thrombosis despite proper anticoagulation. We report the diagnosis and management of a clot-obstruction in a single site cannula placed through the internal jugular vein, guided by transesophageal echocardiography. Case report A 39 year-old male developed acute respiratory distress syndrome and hemodynamic instability after an episode of pulmonary aspiration in the ICU. Eight hours after placement of a single site veno-venous extracorporeal membrane oxygenation, suddenly the perfusionist noticed a reduction in flow. TEE showed a thrombus-like mass obstructing the inflow port in SVC and inflow at IVC was intact. After unsuccessful attempts to reposition the cannula, the team decided to insert additional femoral inflow cannula through the IVC. The single site catheter was then pulled out until its tip was positioned in the right atrium and all three ports of the catheter were switched to the infusion ports. After this, flows and oxygenation improved significantly. Unfortunately, despite all of the efforts, the patient died 2 days later.

Discussion:

The diagnosis of veno-venous extracorporeal membrane oxygenation cannula obstruction is based on reduced inflow rates, hemodynamic instability and poor oxygenation of blood. TEE allows evaluation of the flows inside the cannula and in this case, an obstruction was found. The management presented points to the fact that in a situation of catheter obstruction caused by a clot, there is a feasible alternative to assure minimal interruption of the hemodynamic support offered by the veno-venous extracorporeal membrane oxygenation.
RESUMO
Resumo

Justificativa:

A oxigenação por membrana extracorpórea veno-venosa é terapia estabelecida para pacientes com a síndrome do desconforto respiratório agudo. Uma complicação relacionada ao uso da oxigenação por membrana extracorpórea veno-venosa é trombose apesar de anti-coagulação adequada. Relatamos o diagnóstico e conduta em obstrução por coágulo em cânula de acesso único inserida pela veia jugular interna, guiada por ecocardiografia transesofageana. Relato de caso Paciente do sexo masculino de 39 anos desenvolveu síndrome do desconforto respiratório agudo e instabilidade hemodinâmica após episódio de aspiração pulmonar na UTI. Oito horas após a instalação de oxigenação por membrana extracorpórea veno-venosa de acesso único, o perfusionista notou repentina redução no fluxo. A ETE revelou massa semelhante a um trombo obstruindo o portal de fluxo de entrada na VCS e o fluxo de saída na VCI estava intacto. Após tentativas sem sucesso para reposicionar a cânula, a equipe decidiu inserir cânula de entrada de fluxo adicional pela VCI. O catéter de acesso único foi, então, puxado até que sua ponta se posicionasse no átrio direito e todos os três portais do catéter fossem transferidos para os portais de infusão. A seguir, os fluxos e oxigenação melhoraram significativamente. Infelizmente, apesar dos esforços, o paciente foi a óbito 2 dias depois. Discussão O diagnóstico de obstrução de cânula da oxigenação por membrana extracorpórea veno-venosa se baseia em velocidades reduzidas de entrada de fluxo, instabilidade hemodinâmica e oxigenação pobre do sangue. A ETE permite a avaliação dos fluxos dentro da cânula, e nesse caso foi encontrada obstrução. A técnica apresentada aponta para o fato de que em situação de obstrução de catéter causada por coágulo, existe alternativa factível para garantir interrrupção mínima do suporte hemodinâmico oferecido pela oxigenação por membrana extracorpórea veno-venosa.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Respiratory Distress Syndrome, Newborn / Thrombosis / Extracorporeal Membrane Oxygenation / Cannula Type of study: Diagnostic study / Qualitative research Limits: Adult / Humans / Male Language: English / Portuguese Journal: Rev. bras. anestesiol Journal subject: Anesthesiology Year: 2020 Type: Article Affiliation country: Canada Institution/Affiliation country: University Hospital - London Health Sciences Centre/CA / University of Western Ontario/CA / Western University/CA

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Full text: Available Index: LILACS (Americas) Main subject: Respiratory Distress Syndrome, Newborn / Thrombosis / Extracorporeal Membrane Oxygenation / Cannula Type of study: Diagnostic study / Qualitative research Limits: Adult / Humans / Male Language: English / Portuguese Journal: Rev. bras. anestesiol Journal subject: Anesthesiology Year: 2020 Type: Article Affiliation country: Canada Institution/Affiliation country: University Hospital - London Health Sciences Centre/CA / University of Western Ontario/CA / Western University/CA