A case of long-term extracorporeal membrane oxygenation management with a subxiphoid approach in an infant

IntroductionThe selection of cannulation site is a key consideration for Veno-Venous (V-V) Extracorporeal membrane oxygenation (ECMO) in infants. We report a case of infant, successfully managed with long-term ECMO using a subxiphoid approach.Case reportA 9-month-old girl with respiratory failure was initially managed with Veno-Arterial ECMO. Due to the prolonged duration of ECMO management, we switched to V-V ECMO, via Veno-Arterial-Venous (V-AV) ECMO, using a subxiphoid approach; a small skin incision was made in the subxiphoid area and an L-shaped 14 Fr drainage cannula was placed in the inferior vena cava. The patient was managed with sufficient blood flow and no adverse events.DiscussionThe subxiphoid approach allows the placement of adequately sized drainage cannulas in small children and enables safe conversion to V-V ECMO via V-AV ECMO using a minimally invasive procedure without sternotomy.ConclusionThe subxiphoid approach may represent a feasible option for ECMO cannulation in infants.