{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T04:53:36Z","timestamp":1788411216313,"version":"build-2803163510"},"reference-count":18,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,5,25]]},"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:p>A woman in her 50s who had been diagnosed with COVID-19 developed deep vein thrombosis in the left femoral vein extending into inferior vena cava (IVC). An IVC filter was placed to prevent fatal pulmonary embolism. Her respiratory failure subsequently deteriorated despite optimal mechanical ventilation and required venovenous extracorporeal membrane oxygenation (VV-ECMO) as a rescue therapy. Femoro-jugular VV-ECMO configuration was not suitable due to the IVC filter, hence a single-site venous cannulation using bicaval dual lumen (AvalonElite) cannula was selected. Placement of the Avalon cannula conventionally requires guidance by fluoroscopy or transoesophageal echocardiography, which were not feasible in COVID-19 patients. Hence, transthoracic echocardiography guidance was chosen. Guidewire looping into the right ventricle might lead to cannula malposition and imminent right ventricular rupture, but these could be detected by \u2018bending\u2019 sign. Transthoracic echocardiography could be a feasible guidance method for Avalon cannulation, nonetheless a thorough protocol should be followed to avoid cannula malposition during the procedure.<\/jats:p>","DOI":"10.1136\/bcr-2022-249195","type":"journal-article","created":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T09:05:40Z","timestamp":1664874340000},"page":"e249195","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Bicaval dual lumen cannula placement using transthoracic echocardiography in COVID-19 scenario: pearls and pitfalls"],"prefix":"10.1136","volume":"15","author":[{"given":"Ngoc Minh","family":"Le","sequence":"first","affiliation":[{"name":"Cardiovascular Center, Hanoi Medical University, Hanoi, Viet Nam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uyen The","family":"Dang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Anaesthesia, Hue Central Hospital, Hue, Thua Thien Hue, Viet Nam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ha Viet","family":"Vu","sequence":"additional","affiliation":[{"name":"Department of Emergency and Intensive Care, Hanoi Medical University, Hanoi, Viet Nam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hieu Lan","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Hanoi Medical University, Hanoi, Viet Nam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,6,15]]},"reference":[{"key":"2025082800561894000_15.6.e249195.1","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000001185"},{"key":"2025082800561894000_15.6.e249195.2","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir Med"},{"key":"2025082800561894000_15.6.e249195.3","unstructured":"Annich G . 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