• Darryl Abrams, Daniel Brodie, Jeffrey Javidfar, Keith Brenner, Dongfang Wang, Joseph Zwischenberger, Joshua Sonett, and Matthew Bacchetta.
• Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Columbia University Medical Center, New York-Presbyterian Hospital, New York City, New York 10032, USA.
• ASAIO J. 2012 Nov 1;58(6):636-7.

AbstractVenovenous extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients with primary respiratory failure. Venovenous ECMO can be initiated through a single-site, dual-lumen cannula designed for insertion in the right internal jugular vein. We describe four cases of hypercapnic or hypoxemic respiratory failure, in which we performed single-site cannulation of the left internal jugular vein with 23 Fr or 27 Fr bicaval dual-lumen catheters when the right internal jugular vein was inaccessible because of either stenosis or thrombosis. The surgical approach for left-sided access is similar to the approach used for the right internal jugular vein. The left-sided approach resulted in equivalent blood flow and gas exchange compared with our previous experience with right-sided cannulation. This case series demonstrates the feasibility of placing a bicaval dual-lumen catheter in the left internal jugular vein for the initiation of venovenous ECMO when the right internal jugular vein is inaccessible.

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