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DOI: 10.1055/s-0035-1549359
Comparison of the Avalon Dual-Lumen Cannula with Conventional Cannulation Technique for Venovenous Extracorporeal Membrane Oxygenation
Publikationsverlauf
12. Dezember 2014
16. Februar 2015
Publikationsdatum:
06. Mai 2015 (online)
![](https://www.thieme-connect.de/media/thoracic/201508/lookinside/thumbnails/10-1055-s-0035-1549359_143961oc-1.jpg)
Abstract
Background Comparison of two kinds of cannulation (double-lumen cannula [DLC, Avalon Elite Bicaval Dual Lumen Catheter] and conventional cannulation with two cannulas) for venovenous extracorporeal membrane oxygenation (ECMO) therapy in terms of effectiveness, usage complexity, and costs.
Methods Retrospective case series of 17 patients who received venovenous ECMO therapy due to acute respiratory distress syndrome (ARDS) between January 2010 and March 2012. Nine patients were treated with the DLC and eight patients with conventional cannulation. We analyzed the outcome data, ECMO values, respirator settings, blood gas values, realized prone positioning, and costs, and compared both methods.
Results Both kinds of cannulation are efficient regarding oxygenation and decarboxylation. There is no significant difference in mortality, hospitalization time (intensive care unit [ICU] and hospital) and complications during ECMO therapy between both groups. Cannula implantation is much more complex in the DLC group and requires more experience in TEE (transesophageal echocardiography) diagnostics and cannulation technique. In addition, the costs for the Avalon (MAQUET Cardiopulmonary AG, Germany) cannula are significantly higher than for conventional cannulation. Furthermore, prone positioning could be easier achieved in the DLC group.
Conclusion In summary, double-lumen cannulation allows sufficient gas exchange with more effort (material, technical, and physicians' experience) and higher costs but better mobilization possibilities (particularly prone position) and potential avoidance of deep sedation and mechanical ventilation. From the current point of view, the DLC should be reserved for special cases.
Confirmation about Authorship
Drs. Thomas Kuhl (MD) and Guido Michels (MD, PhD) were responsible for the research, collecting and analyzing the data, as well as paper production. Drs. Thomas Kuhl and Guido Michels together initiated and investigated this important research during their time at the ICU. Both first authors (T. K. and G. M.) and the senior author (T. W.) have contributed equally to the study from inception to preparing of the manuscript.
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References
- 1 Zapol WM, Snider MT, Hill JD , et al. Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA 1979; 242 (20) 2193-2196
- 2 Peek GJ, Mugford M, Tiruvoipati R , et al; CESAR trial collaboration. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009; 374 (9698) 1351-1363
- 3 Morris AH, Wallace CJ, Menlove RL , et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med 1994; 149 (2, Pt 1) 295-305
- 4 Roch A, Lepaul-Ercole R, Grisoli D , et al. Extracorporeal membrane oxygenation for severe influenza A (H1N1) acute respiratory distress syndrome: a prospective observational comparative study. Intensive Care Med 2010; 36 (11) 1899-1905
- 5 Camboni D, Philipp A, Lubnow M , et al. Extracorporeal membrane oxygenation by single-vessel access in adults: advantages and limitations. ASAIO J 2012; 58 (6) 616-621
- 6 Lehle K, Philipp A, Müller T , et al. Flow dynamics of different adult ECMO systems: a clinical evaluation. Artif Organs 2014; 38 (5) 391-398
- 7 Dolch ME, Frey L, Buerkle MA, Weig T, Wassilowsky D, Irlbeck M. Transesophageal echocardiography-guided technique for extracorporeal membrane oxygenation dual-lumen catheter placement. ASAIO J 2011; 57 (4) 341-343
- 8 Kuhl T, Wendt S, Michels G, Langebartels G, Wahlers T. [Percutaneous tracheostomy with use of a laryngeal mask]. Dtsch Med Wochenschr 2012; 137 (9) 442-446
- 9 Hill JD, O'Brien TG, Murray JJ , et al. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med 1972; 286 (12) 629-634
- 10 Bartlett RH, Roloff DW, Cornell RG, Andrews AF, Dillon PW, Zwischenberger JB. Extracorporeal circulation in neonatal respiratory failure: a prospective randomized study. Pediatrics 1985; 76 (4) 479-487
- 11 UK Collaborative ECMO Trail Group. UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation. Lancet 1996; 348 (9020) 75-82
- 12 Peek GJ, Elbourne D, Mugford M , et al. Randomised controlled trial and parallel economic evaluation of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR). Health Technol Assess 2010; 14 (35) 1-46
- 13 Kuhl T, Wendt S, Langebartels G, Kröner A, Wahlers T. Recurrent left atrial and left ventricular thrombosis due to heparin-induced thrombocytopenia: case report and short review. Thorac Cardiovasc Surg 2013; 61 (6) 537-540
- 14 Müller T, Bein T, Philipp A, Graf B, Schmid C, Riegger G. Extracorporeal pulmonary support in severe pulmonary failure in adults: a treatment rediscovered. Dtsch Arztebl Int 2013; 110 (10) 159-166
- 15 Wang D, Zhou X, Liu X, Sidor B, Lynch J, Zwischenberger JB. Wang-Zwische double lumen cannula—toward a percutaneous and ambulatory paracorporeal artificial lung. ASAIO J 2008; 54 (6) 606-611
- 16 Reeb J, Falcoz P-E, Santelmo N, Massard G. Double lumen bi-cava cannula for veno-venous extracorporeal membrane oxygenation as bridge to lung transplantation in non-intubated patient. Interact Cardiovasc Thorac Surg 2012; 14 (1) 125-127
- 17 Garcia JP, Iacono A, Kon ZN, Griffith BP. Ambulatory extracorporeal membrane oxygenation: a new approach for bridge-to-lung transplantation. J Thorac Cardiovasc Surg 2010; 139 (6) e137-e139
- 18 Togo K, Takewa Y, Katagiri N , et al. Impact of bypass flow rate and catheter position in veno-venous extracorporeal membrane oxygenation on gas exchange in vivo. J Artif Organs 2014; [Epub ahead of print]
- 19 Weber-Carstens S, Goldmann A, Quintel M , et al. Extracorporeal lung support in H1N1 provoked acute respiratory failure: the experience of the German ARDS Network. Dtsch Arztebl Int 2013; 110 (33–34) 543-549
- 20 Enger T, Philipp A, Videm V , et al. Prediction of mortality in adult patients with severe acute lung failure receiving veno-venous extracorporeal membrane oxygenation: a prospective observational study. Crit Care 2014; 18 (2) R67
- 21 Hsiao C-C, Chang C-H, Fan P-C , et al. Prognosis of patients with acute respiratory distress syndrome on extracorporeal membrane oxygenation: the impact of urine output on mortality. Ann Thorac Surg 2014; 97 (6) 1939-1944
- 22 Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med 2011; 365 (20) 1905-1914
- 23 Montgomery AB, Stager MA, Carrico CJ, Hudson LD. Causes of mortality in patients with the adult respiratory distress syndrome. Am Rev Respir Dis 1985; 132 (3) 485-489
- 24 Stapleton RD, Wang BM, Hudson LD, Rubenfeld GD, Caldwell ES, Steinberg KP. Causes and timing of death in patients with ARDS. Chest 2005; 128 (2) 525-532
- 25 Javidfar J, Wang D, Zwischenberger JB , et al. Insertion of bicaval dual lumen extracorporeal membrane oxygenation catheter with image guidance. ASAIO J 2011; 57 (3) 203-205
- 26 Guérin C, Reignier J, Richard J-C. Prone positioning in the acute respiratory distress syndrome. N Engl J Med 2013; 369 (10) 980-981
- 27 Kipping V, Weber-Carstens S, Lojewski C , et al. Prone position during ECMO is safe and improves oxygenation. Int J Artif Organs 2013; 36 (11) 821-832
- 28 Guervilly C, Hraiech S, Gariboldi V , et al. Prone positioning during veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adults. Minerva Anestesiol 2014; 80 (3) 307-313
- 29 Masuda Y, Tatsumi H, Imaizumi H , et al. Effect of prone positioning on cannula function and impaired oxygenation during extracorporeal circulation. J Artif Organs 2014; 17 (1) 106-109
- 30 Bein T. [Positioning in mechanical ventilation]. Dtsch Med Wochenschr 2014; 139 (14) 696-698
- 31 Bein T, Weber-Carstens S, Goldmann A , et al. Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus “conventional” protective ventilation (6 mL/kg) in severe ARDS: the prospective randomized Xtravent-study. Intensive Care Med 2013; 39 (5) 847-856
- 32 Chimot L, Marqué S, Gros A , et al. Avalon© bicaval dual-lumen cannula for venovenous extracorporeal membrane oxygenation: survey of cannula use in France. ASAIO J 2013; 59 (2) 157-161
- 33 Javidfar J, Brodie D, Wang D , et al. Use of bicaval dual-lumen catheter for adult venovenous extracorporeal membrane oxygenation. Ann Thorac Surg 2011; 91 (6) 1763-1768 , discussion 1769
- 34 Fuehner T, Kuehn C, Hadem J , et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med 2012; 185 (7) 763-768