Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Department of Infectious Diseases, Nagasaki University Hospital, Nagasaki, Japan.
J Artif Organs. 2022 Jun;25(2):170-173. doi: 10.1007/s10047-021-01290-4. Epub 2021 Aug 16.
Vascular injury associated with cannulation during extracorporeal membrane oxygenation (ECMO) induction is a rare but life-threatening complication. The presence of abnormal vascular anatomy increases the risk of vascular injury and should be recognized before cannulation. We report the case of a patient with coronavirus disease (COVID-19) who was expected to undergo ECMO. By performing computed tomography (CT), we identified the absence of right superior vena cava (RSVC) with a persistent left superior vena cava (PLSVC) that could have caused serious complications associated with ECMO cannulation. PLSVC is observed in less than 0.5% of the general population; however, the combination of PLSVC and an absent RSVC in visceroatrial situs solitus is extremely rare. Attempting cannulation for Veno-venous (VV)-ECMO from the right (or left) internal jugular vein to the right atrium may cause serious complications. Cannulation may fail or lead to complications even in patients with inferior vena cava malformations. Although these vascular abnormalities are rare, it is possible to avoid iatrogenic vascular injury by identifying their presence in advance. Since anatomical variations in the vessels from the deep chest and abdominal cavity cannot be visualized using chest radiography and ultrasonography, we recommend CT, if possible, for patients with severe respiratory failure, including those with COVID-19, who may be considered for VV-ECMO induction.
体外膜肺氧合（ECMO）诱导过程中与插管相关的血管损伤是一种罕见但危及生命的并发症。异常的血管解剖结构会增加血管损伤的风险，应在插管前识别。我们报告了一例患有冠状病毒病（COVID-19）的患者，预计将进行 ECMO。通过进行计算机断层扫描（CT），我们发现右侧上腔静脉（RSVC）缺失，而左侧上腔静脉（PLSVC）持续存在，这可能会导致与 ECMO 插管相关的严重并发症。PLSVC 在普通人群中的发生率低于 0.5%；然而，内脏心房 situs solitus 中 PLSVC 和 RSVC 缺失的组合极为罕见。试图从右侧（或左侧）颈内静脉到右心房进行静脉-静脉（VV）-ECMO 插管可能会导致严重并发症。即使在腔静脉畸形的患者中，插管也可能失败或导致并发症。尽管这些血管异常很少见，但通过提前识别其存在，可以避免医源性血管损伤。由于胸部 X 线和超声检查无法观察到来自深部胸部和腹部的血管的解剖变异，因此我们建议对包括 COVID-19 在内的严重呼吸衰竭患者进行 CT 检查，如果可能的话，以考虑进行 VV-ECMO 诱导。
