Rare complication of extracorporeal membrane oxygenation cannula misplacement into the hepatic vein: A case report

Abstract

Background: 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.

Case summary: 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.

Conclusion: 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.

Keywords: Cannulation; Case report; Critical care; Echocardiography; Extracorporeal membrane oxygenation; Hepatic vein; Infection; Liver; Respiratory failure; Ultrasonography.