V-A ECMO treatment via drainage from the right internal jugular vein to the inferior vena cava ostium for high-risk pulmonary embolism complicated by cardiac arrest with filter placement: case report

BACKGROUND: Patients with high-risk pulmonary embolism complicated by cardiac arrest frequently require V-A ECMO support; however, the traditional peripheral catheterization pathway may be obstructed in patients who have already had an inferior vena cava (IVC) filter implanted. This article aims to investigate alternative ECMO establishment strategies. METHODS: A 68-year-old female patient with acute myeloid leukemia experienced sudden cardiac arrest due to high-risk pulmonary embolism. Due to contraindications to thrombolysis, emergency pulmonary artery thrombus aspiration and IVC filter implantation were performed. However, after repeated episodes of cardiac arrest, conventional femoral vein catheterization proved challenging. Consequently, the "top-in, bottom-out" strategy was employed: a 21Fr porous venous drainage catheter was inserted through the right internal jugular vein under DSA guidance, with the tip positioned at the opening of the IVC, effectively bypassing the filter. The arterial perfusion catheter was placed in the left femoral artery. RESULTS: V-A ECMO was successfully established, leading to improved spontaneous circulation without further cardiac arrests. Nevertheless, the patient ultimately succumbed to disseminated intravascular coagulation (DIC) within 10 hours. CONCLUSION: For high-risk pulmonary embolism patients who have already had an IVC filter implanted, positioning the drainage catheter at the opening of the IVC via the right internal jugular vein offers a viable and effective method for establishing V-A ECMO. This approach provides a novel technical route for critically ill patients where traditional catheterization is limited.