Blood flow disturbance of veno-venous extracorporeal membrane oxygenation (VV-ECMO) can be risk factor of weaning failure. We report an alternative position of cannulae of VV-ECMO which can maintain blood flow. The recirculation rate could be controlled by adjusting a position of return cannula using dilutional ultrasound monitoring.

Optimal positioning of drainage and return cannulae is critically important for minimizing the recirculation in patients with respiratory failure requiring veno-venous extracorporeal membrane oxygenation (VV ECMO). If a drainage cannula is positioned at a low level of right atrium through the femoral vein, flow disturbance due to drainage chattering can occur when the intravascular volume is insufficient, or intrathoracic or intraabdominal pressure is increased. We report a case in which drainage chattering was eliminated and recirculation were decreased by repositioning the drainage and return cannula in a patient with VV ECMO flow disturbance when intrathoracic pressure was increased.

Background: Recent reports have revealed better clinical outcomes for extracorporeal cardiopulmonary resuscitation (ECPR) than conventional cardiopulmonary resuscitation (CPR).In this retrospective study, we attempted to identify predictors associated with successful weaning off extracorporeal membrane oxygenation (ECMO) support after ECPR. Methods: The demographic and clinical data of 30 ECPR patients aged over 18 years treated between August 2016 and January 2019 were analyzed. All clinical data were retrospectively collected. The primary endpoint was successful weaning from ECMO support after ECPR. Patients were divided into two groups based on successful or unsuccessful weaning off ECMO support (Weaned (n=14) vs. Failed (n=16)). Results: Univariate logistic regression analysis showed that age, CPR duration, ECMO complications, and loss of pulse pressure significantly predicted the results of weaning off ECMO support. However, multivariate logistic regression analysis showed that only CPR duration and loss of pulse pressure independently predicted unsuccessful weaning from ECMO support. Conclusion: We conclude that long CPR duration and loss of pulse pressure after ECPR predict unsuccessful weaning from ECMO. However, unlike CPR duration, loss of pulse pressure during post-ECPR was related to subsequent management. In patients with reduced pulse pressure after ECPR, careful management is warranted because this reduction is closely associated with unsuccessful weaning off ECMO support after ECPR.

Many surgeons have modified the technique to reduce bleeding from anastomosis line since Bentall and De Bono introduced aortic root replacement using a composite graft. We present a new composite, butterfly wing shaped, valve graft fixated using hand-made double sewing cuff. The “Wings of a butterfly” technique is a method of reinforcement suturing between an added sewing cuff and residual aortic wall at the proximal stump, and helps to reduce bleeding after the modified Bentall’s procedure.