26, 34, 8
Retrospective review of one year's transthoracic studies assessing bicaval dual-lumen catheter position. A subcostal sagittal bicaval view identified all three catheter ports in 11 of 11 studies. AT LEAST ONE PORT WAS INCORRECTLY POSITIONED IN 5 OF 11 STUDIES. The report also cites a single-sheep experiment in which recirculation rose from 2.1% to 51.3% when the catheter tip was pulled back from the IVC into the right atrium, and an ELSO Registry prevalence of 9% for cannula placement complications, and states that chest radiography is not sensitive in demonstrating malpositioned ECMO catheters.
Authors record that even experienced personnel required additional training, that image quality improved dramatically over the year, and that the process was heavily operator-dependent.
Certainty: very low for the 5-of-11 proportion — eleven studies, one centre, retrospective, and studies were performed because someone suspected a problem. What survives is the direction and the mechanism, both independently confirmed by ELSO Red Book Chapter 48.
Read as indexed full-text passages. DOI not independently resolved.