Venovenous ECMO cannulation in a patient with a pre-existing IVC filter

Excerpt

A 46-year-old female was admitted to our institution for respiratory failure due to pneumonia and heart failure. The patient had a history of recurrent pulmonary embolisms for which she was anticoagulated but also had a previously placed inferior vena cava (IVC) filter for unclear reasons. Her hospital course was complicated by the development of severe acute respiratory distress syndrome. After exhausting maximal efforts, the decision was made to initiate venovenous extracorporeal membrane oxygenation (ECMO). Under the guidance of transesophageal echocardiography and fluoroscopy, jugular and femoral cannulas were inserted without complications. She remained anticoagulated with heparin throughout her ECMO run. She improved clinically and radiographically and was gradually weaned from ECMO. Cannulas were safely removed without dislodgement of the IVC filter on ECMO day 23 (Fig. 1). Contrast-enhanced CT imaging after decannulation did not reveal thrombosis of the IVC filter. The patient was eventually weaned from mechanical ventilation and discharged home after rehabilitation.

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