Echocardiographic guidance for Avalon Elite dual-lumen catheter implantation

Introduction

Venovenous ECMO is a therapeutic option in patients with severe ARDS. The dual-lumen catheter (Avalon Elite; Maquet Medical) offers excellent oxygenation and decarboxylation through a single insertion site and facilitates patient mobilization as it avoids femoral access. As incorrect placement of the catheter might result in perforation and cardiac tamponade, fluoroscopy guidance is advocated in the literature. Transporting an unstable patient for fluoroscopy, however, can endanger the patient.

Methods

We report a retrospective analysis of out-of-center ECMO implantation in patients with severe ARDS. Our center provides a 24/7 service for out-of-hospital ECMO implantation with a team consisting of two intensive care physicians and a perfusionist. In all patients, ECMO therapy was initiated in a non-ECMO center prior to transportation to our hospital. Implantation of a dual-lumen catheter was first choice in all patients and was guided echocardiographically.

Results

Between January 2011 and November 2013, a total of 56 patients (average age 53.3 years) underwent out-of-center venovenous ECMO implantation. In 52 cases (94.6%), a dual-lumen catheter could be implanted successfully using echocardiographic guidance. Either 31 Fr (65.0%) or 27 Fr (35.0%) Avalon Elite catheters were employed. No patient developed any major or even fatal complications related to ECMO implantation. In three out of 56 patients, poor imaging quality or technical issues hampered the implantation of a dual-lumen catheter and a femoral approach had to be made. Concerning short-term survival, 81.0% of all patients could be dismissed from the ICU.

Conclusion

Echocardiographic guidance for out-of-center Avalon Elite catheter implantation is a safe and efficient option when performed by an experienced team.