Percutaneous Decannulation Instead of Surgical Removal for Weaning After Venoarterial Extracorporeal Membrane Oxygenation—A Crossed Perclose ProGlide Closure Device Technique Using a Hemostasis Valve Y Connector

Purpose: In this article, we aimed to elaborate on perioperative and complication management in treatment of pheochromocytoma crisis with extracorporeal membrane oxygenation (ECMO). Material and methods: We report a case of relatively rare grant paraganglioma-induced pheochromocytoma crisis leading to severe circulatory failure, treated with venoarterial extracorporeal membrane oxygenation (V-A ECMO) as a bridge to curative adrenalectomy. Weaning of ECMO was followed by successful surgical removal of the tumor, and patient survival. However, distal ischemia of the cannulated leg occurred during ECMO operation, which eventually led to amputation. In addition, the patient developed new cerebral infarction and left hemiplegia, half a month after paraganglioma resection. Conclusions: We believe that patients with pheochromocytoma crisis, who cannot maintain blood circulation, are eligible for V-A ECMO treatment. Moreover, care should be taken to prevent thrombosis and individualized and precise blood pressure management targets. Early detection and treatment of thrombosis is imperative to long-term prognosis of patients with ECMO.

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Venoarterial extracorporeal membrane oxygenation decannulation using the novel Manta vascular closure device

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620918707 ◽

2020 ◽

Vol 9 (4) ◽

pp. 342-347

Author(s):

Xavier Bemtgen ◽

Timo Heidt ◽

Viviane Zotzmann ◽

Jonathan Rilinger ◽

Tobias Wengenmayer ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Significant Risk ◽

Closure Device ◽

The Novel ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Vessel Stenosis ◽

Patients At Risk ◽

Viable Approach

Aims: Removal of large calibre arterial sheaths, as employed in venoarterial extracorporeal membrane oxygenation, is still associated with a high risk for vascular access site complications. In this study, we investigated the large bore Manta closure device as an option for venoarterial extracorporeal membrane oxygenation decannulation. Methods and results: Sixteen patients weaned from venoarterial extracorporeal membrane oxygenation between January–June 2019 were prospectively included in a registry (eight during extracorporeal cardiopulmonary resuscitation, seven with severe cardiogenic shock and one patient with fulminant pulmonary embolism). All patients had an arterial sheath removed at bedside using the Manta device achieving rapid haemostasis without clinically relevant complications afterwards. A computed tomography angiography was available for 11 patients (68.8%) and reassessed with regards to relevant pathologies at the closure device. Average intraluminal area was 40.4 mm2 (12.2–76.3 mm2) at the closure site. All devices but one were correctly deployed. Three patients (27.3%) had a visible thrombus at the closure device resulting in a >60% stenosis, two of which had a puncture site distal of the femoral artery bifurcation. Conclusion: Decannulation from venoarterial extracorporeal membrane oxygenation using the Manta closure device is a viable approach for rapid haemostasis, but is also associated with a significant risk of thrombotic vessel stenosis. These preliminary findings indicate that puncture in near proximity or distal to the femoral bifurcation might identify patients at risk and further studies are needed.

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Real-time ultrasound-guided bedside closure of arteriotomy wound using MANTA closure device during venoarterial extracorporeal membrane oxygenation decannulation

Perfusion ◽

10.1177/0267659120932429 ◽

2020 ◽

pp. 026765912093242

Author(s):

Shek-Yin Au ◽

Ka-Man Fong ◽

Wing-Yiu George Ng ◽

Kang-Yin Michael Lee ◽

Sheung-On So ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Real Time ◽

Ultrasound Guidance ◽

Percutaneous Closure ◽

Closure Device ◽

Ultrasound Guided ◽

Vascular Closure Device ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation

Percutaneous closure of arteriotomy wound during peripheral venoarterial extracorporeal membrane oxygenation decannulation was shown to be safe and allow earlier mobilization. The new MantaTM vascular closure device (Essential Medical), designed for the closure of arterotomy wound created by large-bore vascular sheaths up to 25Fr during endovascular catheterization procedures, was reported to be applicable in venoarterial extracorporeal membrane oxygenation decannulation. In this article, we would like to share our experience of using real-time ultrasound guidance to ensure the safe application of Manta during bedside venoarterial extracorporeal membrane oxygenation decannulation.

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