Case report: Extracorporeal Membrane Oxygenation Using a Bi-Caval Dual-Lumen Catheter in a Neonate with Persistent Pulmonary Hypertension and Interventricular Septal Hypertrophy

The present case report discusses a neonate who was born via cesarian section at 36+2 wk gestation with a birth weight of 3.66 kg (98th percentile). She needed intubation in delivery room due to persistent low oxygen saturation. Her APGAR score was 5 at 1 min and 7 at 5 min. 

Her cord blood gas investigation revealed moderate acidosis and elevated lactate levels, pH 7.23, PCO2 41mmHg, PO2 29 mmHg, HCO3 17 mEq/L and lactate 3.1 mmol/L.  Initially supported by mechanical ventilation and surfactant, the baby was diagnosed with pulmonary arterial hypertension and interventricular septal hypertrophy. High ventilatory needs led to the use of a high-frequency ventilator and inhaled nitric oxide, followed by IV Sildenafil due to partial response.

With increasing oxygenation index, pediatric extracorporeal membrane oxygenation (ECMO) was initiated. Surgical cut-down was conducted to access to right internal jugular venous. A 13Fr bi-caval dual-lumen catheter was placed under echocardiography guidance. 

Patient was started with veno-venous (VV) ECMO at 8 HOL with a sweep rate of 500 ml/min, fractional sweep oxygen (FsO2) of 1 and pump speed of 2500 rpm to deliver ECMO flow of 500 ml/min. Her oxygenation improved and subsequently, successful decannulation was attained.  She was weaned to nasal ventilation on day 14 and was discharged home on day 42 of life.

This case represents the first reported successful use of neonatal ECMO in India for pulmonary hypertension and septal hypertrophy using a bi-caval dual-lumen catheter. The traditional VV-ECMO uses double cannulation, but a single bi-caval dual-lumen cannula reduces the need and risks associated with accessing two vascular sites.

Source: Dangi, S., Thakur, A., Kler, N. et al. Extracorporeal Membrane Oxygenation with Bi-Caval Dual-Lumen Catheter in a Neonate with Persistent Pulmonary Hypertension and Interventricular Septal Hypertrophy. Indian J Pediatr (2024). https://doi.org/10.1007/s12098-024-05299-4.