Single or Double Site Cannuation for Veno-Venous Ecmo in Severe Obese Patient?

Abstract: Veno - venous extracorporeal membrane oxygenation (VV-ECMO) is an extracorporeal respiratory support used as therapeutic option in patients affected by severe acute respiratory distress syndrome (ARDS), who are not responding to other medical or mechanical treatment. By providing supplementation of pulmonary gas exchange, VV-ECMO allows the lungs to rest and avoids the use of aggressive mechanical ventilation. Therefore, this support provides the basis for a possible recovery of the pulmonary parenchyma damaged by the underlying respiratory disease. Over the last two years, there has been a widespread increase in the use of the VV-ECMO due to the influenza A-H1N1 pandemic. The VV-ECMO approach could be with single or double site cannulation: the single one is performed to reduce the incidence of bleeding, infection and get better the medical and nursing management of the patient (prone position, mobilization, and so on) but this cannulation is a challenge for the mechanical support because of higher resistances, more shunts, much more modification of the flux with a little bit dislocation (for instance during transfer). We reported a case of the first experience of unsuccessful use of single cannulation with VV-ECMO, thus requiring a conversion to dual cannulation with a successful outcome