INTRODUCTION
When veno-venous extracorporeal membrane oxygenation (VV-ECMO) is
applied to a patient with severe respiratory failure, an optimal
cannulation technique is essential to minimize
recirculation.1 Recently, a dual lumen cannula for
VV-ECMO was reported that it was simple and useful for reducing
recirculation.2, 3 The right internal jugular and
right common femoral veins are used in most common for the two vessel
cannulation technique. However, the femoral to internal jugular VV-ECMO
configuration with drainage and return ports in the inferior vena cava
(IVC) and superior vena cava (SVC), respectively, leads to recirculation
because the infusion jet is directed toward the drainage port. On the
other hand, if the drainage cannula is positioned at low level of right
atrium (RA) for decreasing recirculation, flow disturbance due to
drainage chattering from changing intrathoracic or intraabdominal
pressure can occur, can be fatal when a patient is wholly dependent on
VV-ECMO. 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.