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Thorac Cardiovasc Surg 2015; 63(08): 653-662
DOI: 10.1055/s-0035-1549359
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Comparison of the Avalon Dual-Lumen Cannula with Conventional Cannulation Technique for Venovenous Extracorporeal Membrane Oxygenation

Thomas Kuhl
1   Practice of Cardiology, Dormagen, Germany
2   Kreiskrankenhaus Dormagen, Medizinische Klinik, Dormagen, Germany
*   Both first authors contributed equally to the paper.
,
Guido Michels
3   Department III of Internal Medicine, Heartcenter of the University of Cologne, Germany
*   Both first authors contributed equally to the paper.
,
Roman Pfister
3   Department III of Internal Medicine, Heartcenter of the University of Cologne, Germany
,
Stefanie Wendt
4   Department of Cardiothoracic Surgery, University Cologne, Heartcenter, Cologne, Germany
,
Georg Langebartels
4   Department of Cardiothoracic Surgery, University Cologne, Heartcenter, Cologne, Germany
,
Thorsten Wahlers
4   Department of Cardiothoracic Surgery, University Cologne, Heartcenter, Cologne, Germany
› Institutsangaben
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Publikationsverlauf

12. Dezember 2014

16. Februar 2015

Publikationsdatum:
06. Mai 2015 (online)

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Abstract

Background Comparison of two kinds of cannulation (double-lumen cannula [DLC, Avalon Elite Bicaval Dual Lumen Catheter] and conventional cannulation with two cannulas) for venovenous extracorporeal membrane oxygenation (ECMO) therapy in terms of effectiveness, usage complexity, and costs.

Methods Retrospective case series of 17 patients who received venovenous ECMO therapy due to acute respiratory distress syndrome (ARDS) between January 2010 and March 2012. Nine patients were treated with the DLC and eight patients with conventional cannulation. We analyzed the outcome data, ECMO values, respirator settings, blood gas values, realized prone positioning, and costs, and compared both methods.

Results Both kinds of cannulation are efficient regarding oxygenation and decarboxylation. There is no significant difference in mortality, hospitalization time (intensive care unit [ICU] and hospital) and complications during ECMO therapy between both groups. Cannula implantation is much more complex in the DLC group and requires more experience in TEE (transesophageal echocardiography) diagnostics and cannulation technique. In addition, the costs for the Avalon (MAQUET Cardiopulmonary AG, Germany) cannula are significantly higher than for conventional cannulation. Furthermore, prone positioning could be easier achieved in the DLC group.

Conclusion In summary, double-lumen cannulation allows sufficient gas exchange with more effort (material, technical, and physicians' experience) and higher costs but better mobilization possibilities (particularly prone position) and potential avoidance of deep sedation and mechanical ventilation. From the current point of view, the DLC should be reserved for special cases.

Keywords

Avalon/double-lumen cannulation - venovenous ECMO - ARDS - ECMO costs - prone position

Confirmation about Authorship

Drs. Thomas Kuhl (MD) and Guido Michels (MD, PhD) were responsible for the research, collecting and analyzing the data, as well as paper production. Drs. Thomas Kuhl and Guido Michels together initiated and investigated this important research during their time at the ICU. Both first authors (T. K. and G. M.) and the senior author (T. W.) have contributed equally to the study from inception to preparing of the manuscript.