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.
