Hemodynamic instability after the initiation of extracorporeal membrane oxygenation

Purpose: Extracorporeal membrane oxygenation (ECMO) is an established treatment modality for critically ill patients with cardiopulmonary failure, yet little is known of the ocular pathology in this population. The aim of this study is to characterize the posterior segment findings of ECMO patients. Methods: This study is a retrospective analysis of 20 ECMO patients evaluated by ophthalmology from September 2012 to May 2019 at a level 1 trauma center. Comprehensive examinations assessed for intraocular pathology. Demographic data, exam findings, and mortality were analyzed. Results: The sample size consisted of 20 patients; a majority were male (75%), and mean age was 37.4 years (interquartile range, 26.75-50 years). All patients received ECMO for care of acute respiratory distress syndrome (ARDS). Average duration of ECMO therapy was 9.6 ± 6.5 days. Eleven (55%) patients had acute retinal pathology, including Purtscher-like retinopathy (20%), intraocular hemorrhage (50%), and septic chorioretinitis (bacterial or fungal, 10%). Location of hemorrhage included the retina (40%), vitreous (30%), and optic disc (15%). Sixty percent (n = 12) of patients were unable to provide a subjective history on initial assessment. Ultimately, 5 out of 20 patients (25%) died of systemic illness during their hospital stay. Conclusion: This study demonstrates high rates of retinal pathology, most commonly vitreous and/or retinal hemorrhage alongside a Purtscher-like retinopathy. This is likely secondary to complications of anticoagulation, microthrombi, septicemia, and hemodynamic instability. We found a mortality rate slightly lower than that of prior ECMO studies. Prospective studies with pre-ECMO and post-ECMO fundus photography is warranted for better understanding of these medically complex patients.

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Veno-arterial extracorporeal membrane oxygenation for severe fever with thrombocytopenia syndrome with fulminant myocarditis: a case report

BMC Infectious Diseases ◽

10.1186/s12879-021-06446-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Uh. Jin Kim ◽

Hyukjin Park ◽

Kye Hun Kim ◽

Dong Min Kim ◽

Seung Eun Kim ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Cardiac Involvement ◽

Hemodynamic Instability ◽

Multiple Organ ◽

Left Ventricular ◽

Fulminant Myocarditis ◽

Hemodynamic Support ◽

Membrane Oxygenation ◽

Initial Symptoms ◽

Severe Fever

Abstract Background The clinical spectrum of severe fever with thrombocytopenia syndrome (SFTS) is wide, which can range from fever to multiple organ failure. Conservative therapy plays a key role in the treatment of SFTS. However, severe cases of SFTS, such as fulminant myocarditis, may require mechanical hemodynamic support. Case presentation This report presents a case of a 59-year old woman diagnosed with SFTS by reverse-transcription polymerase chain reaction. The patient had no initial symptoms of cardiac involvement and rapidly developed hemodynamic instability 3 days after hospitalization. She suffered from chest pain and had elevated cardiac enzymes. In the absence of atrio-ventricular conduction abnormalities, left ventricular dysfunction, and coronary artery abnormalities by coronary angiography, she was diagnosed with fulminant myocarditis. At that time, her pulse rate nearly dropped to 0 bpm and she developed near complete akinesia of the heart despite vasopressor administration. Veno-arterial extracorporeal membrane oxygenation (ECMO) was initiated with other supportive measures and she fully recovered after 21 days. Conclusions This case indicates that SFTS can cause fulminant myocarditis even without evidence of cardiac involvement at presentation. When symptoms and/or signs of acute heart failure develop in patients with SFTS, myocarditis should be suspected and the patient should be promptly evaluated. Additionally, mechanical hemodynamic support like ECMO can be a lifesaving tool in the treatment of fulminant myocarditis.

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Low cardiac output syndrome requiring extracorporeal membrane oxygenation following pericardiocentesis in an adolescent with Hodgkin Lymphoma: a case report

Perfusion ◽

10.1177/0267659120950604 ◽

2020 ◽

pp. 026765912095060

Author(s):

Toni Matic ◽

Matija Bakos ◽

Dalibor Saric ◽

Miran Cvitkovic ◽

Zrinko Salek ◽

...

Keyword(s):

Cardiac Output ◽

Pericardial Effusion ◽

Extracorporeal Membrane Oxygenation ◽

Hodgkin Lymphoma ◽

Hemodynamic Instability ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output ◽

Membrane Oxygenation ◽

Drainage Rate ◽

Large Pericardial Effusion

We present a case of a 16-year-old male with large pericardial effusion due to Hodgkin Lymphoma (HL). Shortly after drainage of pericardial effusion he developed a low cardiac output syndrome which had to be treated with extracorporeal membrane oxygenation (ECMO). This 9-day ECMO support helped the patient to recover his cardiac function, and thereafter a remission of his primary disease was successfully achieved with chemotherapy. It is a matter of discussion whether a large pericardial effusion with moderate symptoms in patients with HL should be evacuated or just observed since the effusion should ameliorate with chemotherapy. But based upon our experience in this case of hemodynamic instability due to a large effusion requiring evacuation, we propose that pericardiocentesis procedure should be performed with caution at a slow drainage rate of 0.5-1 ml/kg/hour with a maximum rate of 50 ml/hour, to help avoid the low cardiac output syndrome in patients with similar disease conditions.

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Appendicostomy for Intraluminal Antibiotic Administration and Extracorporeal Membrane Oxygenation Support in Severe Hirschsprung's Enterocolitis

The American Surgeon ◽

10.1177/000313481408000913 ◽

2014 ◽

Vol 80 (9) ◽

pp. 844-845

Author(s):

Michael R. Phillips ◽

Kimberly M. Erickson ◽

William T. Adamson ◽

Sean E. McLean

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Developmentally Appropriate ◽

Male Infant ◽

Hemodynamic Instability ◽

Antibiotic Administration ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Hemorrhagic Complications ◽

Pull Through ◽

Laparoscopic Assisted

A term male infant with Hirschsprung's disease underwent an uncomplicated laparoscopic-assisted endorectal pull-through procedure. Four weeks after discharge, the patient developed severe Clostridium difficile enterocolitis with hemodynamic instability and peritonitis. Bedside laparotomy confirmed intestinal viability and accommodated an appendicostomy for antegrade vancomycin colonic irrigations. The patient required venoarterial extracorporeal membrane oxygenation for physiological support for more than six days. Transition to conventional support was successful with survival and discharge from the hospital free from hemorrhagic complications. The patient is now developmentally appropriate for his age.

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