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Figure 1. Chest AP (1A) and result of ELSA monitor (1B) after applying
VV ECMO.
The cannula positioned at superior vena cana and junction of right
atrium and inferior vena cava. The recirculation, measured by ELSA
monitor, was 28%. (yellow and black dot arrow; return and drainage
cannula)
Figure 2. Alternative position of cannulae (2A) and ELSA monitor during
changing a position of cannulae (2B).
Overlap distance was 8.75cm between a return (yellow arrow) and a
drainage cannula (black dot arrow) Before repositioning procedure, a
recirculation rate was 26%. After advancing the drainage until superior
vena cava, and return cannula 2cm, a recirculation rate increased 30%.
After advancing the return cannula 1cm additionally, a recirculation
rate was 24%. The next day, a recirculation rate was 14% after VV-ECMO
flow was decreased.
Figure 3. The schematic figure for the alternative position of cannulae.
This alternative position of cannulae in VV-ECMO can drain from superior
and inferior vena cava (blue arrow) but develop the recirculation
(violet arrow). The optimal position of the return cannula is determined
by dilution ultrasound monitoring, which position may make oxygenated
blood (red arrow) flow to the right ventricle.