Technique
Under fluoroscopy guidance in the operating room, the left subclavian
was percutaneously accessed with Seldinger’s technique. An Amplatz Super
Stiff guidewire (0.035 inch â«» 260 cm; Boston Scientific, Natick, MA) was
positioned into the right atrium and inferior vena cava. After serial
dilation, the 28 French CrescentTM Jugular Dual Lumen
Catheter (Medtronic, Minneapolis, Minnesota) was advanced under
fluoroscopic and transesophageal echocardiographic guidance with the
infusion jet facing the tricuspid valve. Placement of the
CrescentTM Catheter was confirmed while maintaining
full ECMO support from the previously circuit to ensure patient
stability throughout the procedure (Figure 1) . Once positioned,
the previous cannulas were clamped and removed after properly splicing
the new dual lumen cannula to the ECMO circuit (Figure 2A and
B) .
Since the conversion of cannulation strategies, the patient continued to
improve. Her remaining BPF have healed and her activity level continues
to improve each day.