EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) CANNULA MALPOSITION IDENTIFIED THROUGH POINT-OF-CARE ULTRASOUND

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: In adult ECMO, veno-venous (VV) dual lumen intrajugular (IJ) cannula placement is verified intra-procedurally with echocardiogram and monitored daily chest radiography (CXR) while bi-femoral lines are pelvic films. Worsening ECMO support prompts evaluation for malposition. Radiographs may suggest proper despite malposition, which associated complications such as insufficient venous drainage, vessel obstruction/occlusion, trauma to surrounding anatomic structures. these cases, ultrasound remains a portable, fast inexpensive tool identify correct We report three cases of malpositioned VV cannulas identified through bedside POCUS appearing appropriately positioned radiographically. CASE PRESENTATION: 27-year-old female Hodgkin's lymphoma suspected bleomycin induced lung injury. Cannulated via IJ progressive refractory hypoxemia, line intraoperatively. Daily CXR commented "ECMO in appropriate position". Developed increasing evidence recirculation, showed outflow jet distally the hepatic vein. Recirculation improved retraction under guidance. 30-year-old male rapidly interstitial disease, intubated cannulated bridge transplant. After cannulation, he recirculation low flows (SpO2 88%, ScVO2 82%, flow 2.1 Lpm). "dual side hole right atrium, distal tip IVC". Support immediately once retracted 41-year-old ARDS hypoxemia underwent cannulation. On day hospitalization, began cutting out had marginal fluids, on 1 3 both terminating cavo-atrial junction". return vein partially entering when it been RA days 1-2 ultrasonographically. DISCUSSION: Cannulas anchored by sutures prevent displacement. Any change position be noted follow-up radiographs. However, radiographs static images, discerning minor changes challenging. Each malpositions were missed radiography. Currently there no guidelines ultrasonographic monitoring position. Further investigation into benefits over course warranted. CONCLUSIONS: complete help reduce from malpositioning phase support. REFERENCE #1: Douflé G, Roscoe A, Billia F, Fan E. Echocardiography patients supported extracorporeal membrane oxygenation [published correction appears Crit Care. 2016;20:34]. 2015;19:326. Published 2015 Oct 2. doi:10.1186/s13054-015-1042-2 #2: Lee S, Chaturvedi A. Imaging adults (ECMO). Insights Imaging. 2014;5(6):731-742. doi:10.1007/s13244-014-0357-x #3: Victor K, Barrett N, Glover Kapetanakis Langrish C. Acute Budd-Chiari syndrome during diagnosed using transthoracic echocardiography. Br J Anaesth. 2012 Jun;108(6):1043-4. doi: 10.1093/bja/aes161. PMID: 22593140. DISCLOSURES: No relevant relationships Taylor Becker, source=Web Response Charles Rappaport, Roger Struble,