A 71‐year‐old man was admitted to the emergency department with cardiac arrest. He presented refractory shock after the return of spontaneous circulation, and was indicated for venoarterial extracorporeal membrane oxygenation (ECMO). Sheath introducers were placed in the right femoral artery and left femoral vein under ultrasound guidance, and no problems were noted during the procedures. We canceled ECMO due to the resolution of shock while being cannulated. Computed tomography scan revealed a femorofemoral bypass with the tip of the sheath introducer placed within the artificial graft (Fig. 1). Femorofemoral bypass was not mentioned in the patient’s medical history provided by his family. It was difficult to recognize the surgical scar as it was significantly faded.
Fig. 1
Sheath introducer (red arrowheads) that strayed during extracorporeal membrane oxygenation cannulation in a 71‐year‐old man who had undergone previous femorofemoral bypass (blue arrowheads).
Sheath introducer (red arrowheads) that strayed during extracorporeal membrane oxygenation cannulation in a 71‐year‐old man who had undergone previous femorofemoral bypass (blue arrowheads).Ultrasound is recommended for cannulating patients for ECMO.
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However, even if the ultrasound findings are normal at the insertion points, the tip may proceed into unexpected locations. Ultrasound can also confirm guidewire travel in the inferior vena cava, but intestinal gas can easily block the view. Confirmation by X‐ray fluoroscopy or a portable X‐ray device is also recommended for ECMO implementation, but X‐ray alone might not detect displacement consistently.
Therefore, we recommend confirming the endoluminal guidewire with ultrasound and the guidewire travel with X‐rays for a safe ECMO implementation.
DISCLOSURE
Approval of the research protocol: N/AInformed consent: We obtained written informed consent from the patient’s family.Registry and registration no. of the study/trial: N/A.Animal studies: N/AConflict of interest: None.
Fig. 1