Li Kun, Pan Xue-Jia, Liu Ting-Ting, Guo Hong-Yu, Fang Xue-Ling
Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China.
Department of Nursing, Hangzhou Xiaoying Community Health Service Center, Hangzhou 310000, Zhejiang Province, China.
World J Gastrointest Surg. 2025 May 27;17(5):105023. doi: 10.4240/wjgs.v17.i5.105023.
Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a lifesaving intervention for severe respiratory failure; however, its effectiveness depends on accurate cannulation-patients with anatomical variations present with significant challenges during the procedure.
We describe the case of a 56-year-old woman with severe pulmonary infection and acute respiratory failure managed with V-V ECMO. During the initial cannulation, a 23Fr venous drainage cannula was inadvertently inserted into the middle hepatic vein (HV) instead of the inferior vena cava (IVC) owing to the enlargement of the HV (1.02 cm diameter) and its acute angle (77.78°) relative to the IVC. This misplacement led to extracorporeal membrane oxygenation (ECMO) flow issues which were resolved after repositioning the cannula under real-time ultrasonographic and fluoroscopic guidance. This correction stabilized the patient's condition and restored effective ECMO function, preventing severe complications such as liver injury and liver failure.
In clinical practice, real-time ultrasonography and fluoroscopy are critical in preventing cannulation errors in patients with anatomical variations. Vigilant imaging and precise techniques are essential for optimizing ECMO management and effectively addressing complications.
静脉-静脉体外膜肺氧合（V-V ECMO）是治疗严重呼吸衰竭的一种挽救生命的干预措施；然而，其有效性取决于准确的插管——存在解剖变异的患者在该过程中面临重大挑战。
我们描述了一例56岁患有严重肺部感染和急性呼吸衰竭并接受V-V ECMO治疗的女性病例。在初次插管时，由于肝中静脉（HV）直径增大（直径1.02 cm）且其相对于下腔静脉（IVC）呈锐角（77.78°），一根23Fr静脉引流插管被误插入肝中静脉而非下腔静脉。这种误置导致了体外膜肺氧合（ECMO）血流问题，在实时超声和荧光透视引导下重新定位插管后问题得到解决。此次纠正稳定了患者病情并恢复了有效的ECMO功能，预防了肝损伤和肝衰竭等严重并发症。
在临床实践中，实时超声检查和荧光透视对于预防存在解剖变异患者的插管错误至关重要。警惕的影像学检查和精确的技术对于优化ECMO管理及有效应对并发症必不可少。
