Refractory cardiac arrest, inferior vena cava agenesis and extracorporeal cardiopulmonary resuscitation: a demanding combination.

Inferior vena cava abnormalities or agenesis had to be suspected in front of technical difficulties during venous catheterization. In the setting of extracorporeal life support and during chest compressions, femoral vascular access is the easiest, most efficient and, perhaps, the first approach for a successful extracorporeal cardiopulmonary resuscitation. In the case of inferior vena cava agenesis leading to cannulation failure and/or complications, the use of the right internal jugular vein for salvage venous cannulation is a potential life-saving strategy.