Parallel veno-venous and veno-arterial extracorporeal membrane circuits for coexisting refractory hypoxemia and cardiovascular failure: a case report

Abstract Background The complexity of extracorporeal membrane oxygenation (ECMO) techniques continues to evolve. Different cannulation methods and configurations have been proposed as a response to a challenging cardiovascular and pulmonary physiology of the patients. The use of parallel ECMO circuits represents a unique and novel approach for patients with refractory respiratory failure and cardiovascular collapse with very large body surface areas. Case presentation We present the case of a 25-year-old morbidly obese male patient admitted for severe acute respiratory distress syndrome (ARDS) and refractory hypoxemia, requiring institution of double cannulation for veno-venous ECMO. Since his hypoxemia persisted, likely due to insufficient flows given his large body surface area, an additional drainage venous cannula was implemented to provide higher flows, temporarily addressing his oxygenation status. Unfortunately, the patient developed concomitant cardiogenic shock refractory to inotropic support and extracorporeal fluid removal, further worsening his oxygenation status, thus the decision was to institute four-cannulation/parallel-circuits veno-venous and veno-arterial ECMO, successfully controlling both refractory hypoxemia and cardiogenic shock. Conclusions Our case illustrates a novel and complex approach for combined severe ARDS and cardiovascular collapse through the use of parallel veno-venous and veno-arterial ECMO circuits, and exemplifies the expansion of ECMO techniques and its life-saving capabilities when conservative approaches are futile.

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Acute Effects of Left Ventricular Support With Impella 5.5 on Biventricular Hemodynamics

Circulation Heart Failure ◽

10.1161/circheartfailure.121.008616 ◽

2021 ◽

Author(s):

Kay D. Everett ◽

Pankaj Jain ◽

Richard Botto ◽

Michael Salama ◽

Satoshi Miyashita ◽

...

Keyword(s):

Heart Failure ◽

Right Ventricle ◽

Cardiogenic Shock ◽

Left Ventricular ◽

Acute Effects ◽

Hemodynamic Evaluation ◽

Novel Approach ◽

Ventricular Support

Identification of patients with cardiogenic shock and right ventricle (RV) dysfunction who may require biventricular rather than isolated left ventricular (LV) support remains challenging. In this setting, rigorous hemodynamic evaluation of biventricular contractility and load during initiation of LV support guides therapy. We now report a novel approach to assess biventricular pressure-volume loops in a patient receiving Impella 5.5 support for heart failure and shock.

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Cardiovascular functions in the dog rewarmed rapidly and slowly from deep hypothermia

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1960.198.2.333 ◽

1960 ◽

Vol 198 (2) ◽

pp. 333-335 ◽

Cited By ~ 3

Author(s):

H. E. D'Amato ◽

Suzanne Kronheim ◽

B. G. Covino

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Cardiac Output ◽

Superior Vena ◽

Vena Cava ◽

Deep Hypothermia ◽

Cardiovascular Collapse ◽

Cardiovascular Failure ◽

Myocardial Failure ◽

Cardiovascular Functions

Heart rate, blood pressure, cardiac output and cardiac minute work were measured in pentobarbitalized dogs prior to induction of hypothermia, at rectal temperatures of 25°C or 20°C and following rapid rewarming in warm water or slow rewarming by wrapping in heated sheeting. During rapid rewarming from either 25°C or 20°C no consistent failure in recovery of normal cardiovascular function was observed, although 1 out of 10 dogs did suffer cardiovascular collapse during rapid rewarming. Slow rewarming from 25° and 20°C resulted in consistent failure of some or all of these functions to recover to prehypothermic levels. Moreover, 5 out of 15 slowly rewarmed dogs suffered cardiovascular collapse during the rewarming process. In five dogs slowly rewarmed from 20°C saline was infused into the superior vena cava. This procedure resulted in moderate increases in blood pressure but dramatic increases in cardiac output and minute work (200% and 270%, respectively), thereby negating myocardial failure as the primary cause of the occasionally observed cardiovascular failure.

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A novel approach to Verify air gap and SSD for proton radiotherapy using surface imaging

Radiation Oncology ◽

10.1186/s13014-019-1436-4 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Xiao Wang ◽

Chi Ma ◽

Rihan Davis ◽

Rahul R. Parikh ◽

Salma K. Jabbour ◽

...

Keyword(s):

Body Surface ◽

Imaging System ◽

Air Gap ◽

Surface Imaging ◽

Proton Radiotherapy ◽

Optical Surface ◽

Air Gaps ◽

Novel Approach ◽

Proton Treatment ◽

The Absolute

Abstract Purpose To develop a novel approach to accurately verify patient set up in proton radiotherapy, especially for the verification of the nozzle – body surface air gap and source-to-skin distance (SSD), the consistency and accuracy of which is extremely important in proton treatment. Methods Patient body surfaces can be captured and monitored with the optical surface imaging system during radiation treatment for improved intrafraction accuracy. An in-house software package was developed to reconstruct the patient body surface in the treatment position from the optical surface imaging reference capture and to calculate the corresponding nozzle – body surface air gap and SSD. To validate this method, a mannequin was scanned on a CT simulator and proton plans were generated for a Mevion S250 Proton machine with 20 gantry/couch angle combinations, as well as two different snout sizes, in the Varian Eclipse Treatment Planning Systems (TPS). The surface generated in the TPS from the CT scan was imported into the optical imaging system as an RT Structure for the purpose of validating and establishing a benchmark for ground truth comparison. The optical imaging surface reference capture was acquired at the treatment setup position after orthogonal kV imaging to confirm the positioning. The air gaps and SSDs calculated with the developed method from the surface captured at the treatment setup position (VRT surface) and the CT based surface imported from the TPS were compared to those calculated in TPS. The same approach was also applied to 14 clinical treatment fields for 10 patients to further validate the methodology. Results The air gaps and SSDs calculated from our program agreed well with the corresponding values derived from the TPS. For the phantom results, using the CT surface, the absolute differences in the air gap were 0.45 mm ± 0.33 mm for the small snout, and 0.51 mm ± 0.49 mm for the large snout, and the absolute differences in SSD were 0.68 mm ± 0.42 mm regardless of snout size. Using the VRT surface, the absolute differences in air gap were 1.17 mm ± 1.17 mm and 2.1 mm ± 3.09 mm for the small and large snouts, respectively, and the absolute differences in SSD were 0.81 mm ± 0.45 mm. Similarly, for patient data, using the CT surface, the absolute differences in air gap were 0.42 mm ± 0.49 mm, and the absolute differences in SSD were 1.92 mm ± 1.4 mm. Using the VRT surface, the absolute differences in the air gap were 2.35 mm ± 2.3 mm, and the absolute differences in SSD were 2.7 mm ± 2.17 mm. Conclusion These results showed the feasibility and robustness of using an optical surface imaging approach to conveniently determine the air gap and SSD in proton treatment, providing an accurate and efficient way to confirm the target depth at treatment.

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A 64-Year-Old Man With Refractory Hypoxemia in Cardiogenic Shock

CHEST Journal ◽

10.1378/chest.12-2433 ◽

2013 ◽

Vol 143 (6) ◽

pp. 1819-1821

Author(s):

Kelly A. Cawcutt ◽

Michael E. Wilson ◽

Kimberly J. Carter ◽

Fabien Maldonado

Keyword(s):

Cardiogenic Shock ◽

Refractory Hypoxemia

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Cardiac replacement in postcardiotomy cardiogenic shock - a novel approach

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2005-861950 ◽

2005 ◽

Vol 53 (S 01) ◽

Author(s):

A El-Banayosy ◽

L Arusoglu ◽

M Morshuis ◽

L Kizner ◽

P Sarnowski ◽

...

Keyword(s):

Cardiogenic Shock ◽

Novel Approach ◽

Postcardiotomy Cardiogenic Shock

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Successful emergency management of a bleeding tracheoinnominate fistula

BMJ Case Reports ◽

10.1136/bcr-2019-232257 ◽

2019 ◽

Vol 12 (12) ◽

pp. e232257

Author(s):

Lachlan Donaldson ◽

Raymond Raper

Keyword(s):

Emergency Management ◽

Body Surface ◽

Foley Catheter ◽

Median Sternotomy ◽

Innominate Artery ◽

Massive Haemorrhage ◽

Novel Approach ◽

Temporary Control ◽

Definitive Management ◽

Percutaneous Insertion

In this case, we describe a novel approach to achieving temporary haemostasis in acute massive haemorrhage from a bleeding tracheoinnominate fistula. We report the case of a 42-year-old man admitted to hospital after suffering 80% body surface area burns. Thirty days following the percutaneous insertion of a tracheostomy, spontaneous massive haemorrhage occurred via the tracheostomy stoma, the tracheostomy tube and the mouth. After hyperinflation of the tracheostomy cuff which controlled airway contamination, effective tamponade was achieved using a hyperinflated balloon on a Foley catheter that was introduced by direct laryngoscopy into the upper larynx above the tracheotomy stoma. This provided temporary control of the bleeding until definitive management through ligation of the innominate artery via median sternotomy.

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