Optimal Endovascular Methods for Placement of Bicaval Dual-Lumen Cannulae for Venovenous Extracorporeal Membrane Oxygenation

Early mobility is associated with improved outcomes in critically ill patients with acute respiratory failure. The Avalon Elite Bicaval Dual-Lumen cannula provides support for extracorporeal membrane oxygenation through a single cannula in the internal jugular position in the neck, avoiding femoral cannulation. This allows the patient to participate in early mobility and strength exercises, facilitating early reconditioning. Placement of the Avalon bicaval cannula poses a potential risk of intracardiac placement and right ventricular rupture as a result of the flexibility of the guidewire. We present our endovascular technique for Avalon bicaval cannula placement with fluoroscopic guidance to prevent inadvertent intracardiac placement.