IMPORTANT! Cardiovasular Perforation During Placement of an Avalon

A Recent publication in the Journal of Cardiac Surgery from the Children’s Hospital of Philadelphia describes the importance of using echocardiography in placement of the Avalon Elite Bicaval Dual Lumen Cannula in neonates for VV ECMO.

The authors share some very important points in their conclusion:

  • “Fluid shifts are frequent after initiation of ECMO and are a common cause of systemic hypotension and impaired venous return to the pump, events that typically respond to fluid boluses. Because a slow developing cardiac tamponade causes the same signs and also responds (initially) to fluid boluses, it is somewhat difficult to clinically distinguish between the two at the early stages of development.”
  • “As illustrated by our report, the echocardiography at the time of cannulation may fail to detect minor cardiovascular injuries.”
  • “Because of this and the known potential risk of cardiovascular perforation, we believe that it is critical to perform routine surveillance echocardiography within the first hours after Avalon Elite cannula placement, and to have a low threshold to repeat the study if the venous return to the pump becomes impaired at any time.”
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