A modified technique for insertion of dual lumen bicaval cannulae for venovenous extracorporeal membrane oxygenation

Venovenous extracorporeal membrane oxygenation is used increasingly in adults with severe acute reversible respiratory failure. Cannulation is associated with a risk of vascular damage or cardiac perforation. This report describes a modified technique of insertion for dual lumen bicaval cannulae. We have adopted the technique on 25 occasions and had no incidence of vascular damage or cardiac perforation. We suggest that the technique may mitigate the risk of guidewire looping during insertion of the dilators/cannula and thereby reduce the risk of perforation of the right ventricle.