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This is the peer reviewed version of the following article: Tanaka, D., Pitcher, H. T., Cavarocchi, N., & Hirose, H. (2015). Migrated avalon veno-venous extracorporeal membrane oxygenation cannula: How to adjust without interruption of flow. Journal of Cardiac Surgery, 30(11), 865-868, which has been published in final form at DOI: 10.1111/jocs.12629. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.


The Avalon dual lumen cannula is presently the cannula of choice for veno-venous extracorporeal membrane oxygenation (VV-ECMO) via right internal jugular cannulation. This cannula establishes VV-ECMO with a single cannulation; however, it requires appropriate positioning to gain adequate oxygenation. Malposition of this cannula can cause inadequate ECMO flow, hypoxia, and structural injury. We have experienced two cases of migration: one into the hepatic vein and the other into the right ventricle. The former was repositioned using echocardiographic guidance without using a guidewire. The latter was repositioned using a guidewire from the femoral vein under fluoroscopy, without antegrade wire placement into the Avalon cannula, discontinuation of ECMO, or bleeding.

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