Kronfli Anthony, Pasrija Chetan, Shah Aakash, Ghoreishi Mehrdad, Garcia Jose P, Pham Si M, Sanchez Pablo G, Kon Zachary N
Department of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
Department of Cardiothoracic Surgery, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA.
Heart Surg Forum. 2016 Dec 14;19(6):E282-E283. doi: 10.1532/hsf.1569.
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an ever-emerging method of managing respiratory failure in patients who are refractory to conventional mechanical ventilatory support. An increasingly common method of cannulation involves placement of a bicaval dual-lumen, single cannula via the right internal jugular (IJ) vein. Thrombus in this vein has been considered a contraindication for cannula placement.
A 45-year-old Hispanic male presented with bleomycin-induced respiratory failure resulting in acute respiratory distress syndrome (ARDS). Ambulatory VV-ECMO support was initiated, and during surgical cannula placement an occlusive thrombus was noted in the right IJ vein. A tract was dilated and the cannula was placed without any thromboembolic complications.
This case demonstrates that cannulation for ambulatory VV-ECMO in the setting of an occlusive IJ thrombus can be safe and feasible.
静脉-静脉体外膜肺氧合（VV-ECMO）是一种用于治疗对传统机械通气支持无效的呼吸衰竭患者的新兴方法。一种越来越常见的插管方法是通过右颈内静脉放置双腔双腔单根插管。该静脉内的血栓一直被视为插管的禁忌症。
一名45岁的西班牙裔男性因博来霉素诱导的呼吸衰竭导致急性呼吸窘迫综合征（ARDS）。开始进行门诊VV-ECMO支持，在手术插管过程中，发现右颈内静脉有闭塞性血栓。扩张通道并放置插管，未出现任何血栓栓塞并发症。
该病例表明，在存在闭塞性颈内静脉血栓的情况下，进行门诊VV-ECMO插管是安全可行的。
