Vascular anatomical considerations and clinical decision making during insertion of the Avalon^® Elite Dual Lumen single-site veno-venous ECMO cannula in children weighing less than 20 kg

The correct selection and placement of a single-site Avalon^® Elite Dual Lumen Cannula for veno-venous extracorporeal membrane oxygenation (ECMO) in children weighing less than 20 kg is dependent on both the mechanical characteristics of the catheter, including length and diameter, as well as the unique vascular anatomic considerations of the patient. This manuscript describes the development of a clinical strategy, over a four-year period from 2012-2016, for cannula selection to reduce the risk of migration and malposition in 20 critically ill children weighing less than 20 kg who presented for veno-venous ECMO.