Optimal Methods to Secure Extracorporeal Membrane Oxygenation Bicaval Dual-Lumen Cannulae: What Works?

Ambulation while on extracorporeal membrane oxygenation (ECMO) is critical to facilitate native pulmonary recovery for patients with acute respiratory failure and is a prerequisite for listing for lung transplantation to achieve optimal outcomes. The development of a bicaval dual-lumen cannula capable of providing venovenous (VV) ECMO support via the internal jugular vein has greatly facilitated ambulation and rehabilitation programs. But cannula dislodgement is a serious concern with ambulation and rehabilitation, especially when minor cannula migration can significantly impact VV-ECMO flow. We review an optimal technique to secure dual-lumen cannula to facilitate early mobility, ambulation, and rehabilitation and prevent ECMO cannula dislodgement.