Conversion to central cannulation following azygous vein cannulation in right congenital diaphragmatic hernia

Abstract Right-sided congenital diaphragmatic hernia (R-CDH) can be associated with variations in anatomy that make extracorporeal membrane oxygenation (ECMO) cannulation challenging. We report a case of azygous vein cannulation in a R-CDH patient requiring ECMO. The venous cannula passed directly from the right internal jugular vein into the azygous vein and failed to provide adequate venous return. Cannula repositioning was unsuccessful which led to an urgent planned conversion to central cannulation with a successful outcome. The risk of azygous vein cannulation is increased in patients with R-CDH due to the anatomic distortions that are unique to this subset. Azygous vein cannulation should be considered when inadequate venous return on the ECMO circuit occurs, especially in a R-CDH patient. Central cannulation should be available if the venous cannula cannot be repositioned into the superior vena cava (SVC).