Thrombosis of the Right Internal Jugular Vein is Not a Contraindication to Ambulatory Veno-Venous Extracorporeal Membrane Oxygenation with a Bicaval Dual-Lumen, Single Cannula System

Background: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an ever-emerging method of managing respiratory failure in patients who are refractory to conventional mechanical ventilatory support. An increasingly common method of cannulation involves placement of a bicaval dual-lumen, single cannula via the right internal jugular (IJ) vein. Thrombus in this vein has been considered a contraindication for cannula placement. Case report: A 45-year-old Hispanic male presented with bleomycin-induced respiratory failure resulting in acute respiratory distress syndrome (ARDS). Ambulatory VV-ECMO support was initiated, and during surgical cannula placement an occlusive thrombus was noted in the right IJ vein. A tract was dilated and the cannula was placed without any thromboembolic complications. Conclusion: This case demonstrates that cannulation for ambulatory VV-ECMO in the setting of an occlusive IJ thrombus can be safe and feasible.