scholarly journals Harlequin Syndrome during Venoarterial Extracorporeal Membrane Oxygenation

2019 ◽  
Vol 1 (2) ◽  
pp. e190031
Author(s):  
Chetan Pasrija ◽  
Kareem Bedeir ◽  
Jean Jeudy ◽  
Zachary N. Kon
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Harlequin Syndrome

scholarly journals A novel veno-arteriovenous extracorporeal membrane oxygenation with double pump for the treatment of Harlequin syndrome

Perfusion ◽  
2020 ◽  
Vol 35 (1_suppl) ◽  
pp. 65-72 ◽  
Author(s):  
Carlo Contento ◽  
Andrea Battisti ◽  
Bruno Agrò ◽  
Marina De Marco ◽  
Alessandra Iaiza ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Blood Clot ◽  
The Body ◽  
Clotting Factor ◽  
Centrifugal Pumps ◽  
Blood Flows ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Harlequin Syndrome ◽  
Venovenous Extracorporeal Membrane Oxygenation

Objectives: The Harlequin syndrome is a complication observed in patients receiving peripheral venoarterial extracorporeal membrane oxygenation. This condition is defined as a critical variation in the oxygen saturation between the upper and the lower part of the body deriving from a poor lung function. Methods: Between July 2018 and November 2019, a total of 60 patients (42 men and 18 women; mean age 57.4 ± 10.0 years; range = 28-71 years) underwent peripheral venoarterial extracorporeal membrane oxygenation in our center. Harlequin syndrome was identified in eight cases (six men and two women; 13.3%) of the 60 venoarterial extracorporeal membrane oxygenation–supported patients. As a result of the Harlequin syndrome, all these patients required conversion to veno-arteriovenous extracorporeal membrane oxygenation. Control and monitoring of the blood flows of the return cannulae were performed using two centrifugal pumps, one for each inlet line, according to the patient requirements to achieve optimum hemodynamic and oxygenation. Results: Mean duration of veno-arteriovenous extracorporeal membrane oxygenation support was 5.3 ± 1.4 days. Seven patients (87.5%) were switched to venovenous extracorporeal membrane oxygenation, and after 13.5 ± 2.7 days, those patients were totally weaned from extracorporeal membrane oxygenation support. One patient (12.5%) had an improvement in the pulmonary function, but the cardiac function was poor. This patient was switched to venoarterial extracorporeal membrane oxygenation, and after 10 days, the patient was completely weaned from extracorporeal membrane oxygenation support. Conclusion: The use of a secondary centrifugal pump to manage the blood flow directed to the internal jugular vein, in the veno-arteriovenous extracorporeal membrane oxygenation setup, allows the reduction in the risk of blood clot formation, clotting factor consumption, and pulmonary embolism when compared to the use of an external clamp.

Long‐term renal function after venoarterial extracorporeal membrane oxygenation

2021 ◽  
Vol 36 (3) ◽  
pp. 815-820
Author(s):  
Brian Ayers ◽  
Milica Bjelic ◽  
Neil Kumar ◽  
Katherine Wood ◽  
Bryan Barrus ◽  
...  
Keyword(s):  
Renal Function ◽  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation

scholarly journals Biventricular Unloading with Impella and Venoarterial Extracorporeal Membrane Oxygenation in Severe Refractory Cardiogenic Shock: Implications from the Combined Use of the Devices and Prognostic Risk Factors of Survival

2021 ◽  
Vol 10 (4) ◽  
pp. 747
Author(s):  
Georgios Chatzis ◽  
Styliani Syntila ◽  
Birgit Markus ◽  
Holger Ahrens ◽  
Nikolaos Patsalis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Risk Scores ◽  
Circulatory Support ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Refractory Cardiogenic Shock ◽  
Lactate Levels ◽  
Va Ecmo

Since mechanical circulatory support (MCS) devices have become integral component in the therapy of refractory cardiogenic shock (RCS), we identified 67 patients in biventricular support with Impella and venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) for RCS between February 2013 and December 2019 and evaluated the risk factors of mortality in this setting. Mean age was 61.07 ± 10.7 and 54 (80.6%) patients were male. Main cause of RCS was acute myocardial infarction (AMI) (74.6%), while 44 (65.7%) were resuscitated prior to admission. The mean Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment Score (SOFA) score on admission was 73.54 ± 16.03 and 12.25 ± 2.71, respectively, corresponding to an expected mortality of higher than 80%. Vasopressor doses and lactate levels were significantly decreased within 72 h on biventricular support (p < 0.05 for both). Overall, 17 (25.4%) patients were discharged to cardiac rehabilitation and 5 patients (7.5%) were bridged successfully to ventricular assist device implantation, leading to a total of 32.8% survival on hospital discharge. The 6-month survival was 31.3%. Lactate > 6 mmol/L, vasoactive score > 100 and pH < 7.26 on initiation of biventricular support, as well as Charlson comorbity index > 3 and prior resuscitation were independent predictors of survival. In conclusion, biventricular support with Impella and VA-ECMO in patients with RCS is feasible and efficient leading to a better survival than predicted through traditional risk scores, mainly via significant hemodynamic improvement and reduction in lactate levels.

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