scholarly journals Successful Decannulation of Hybrid ECMO Circuitry: The First Philippine Experience

2021 ◽  
Vol 30 (2) ◽  
pp. 1-4
Author(s):  
Renato C. Jr. Ong ◽  
Maria Stephanie Alessa R. Sales-Florentino ◽  
Frederick H. Verano ◽  
Rod T. Castro ◽  
Jillian Mae L. Tabora-Lacdao ◽  
...  
Keyword(s):  
Clinical Status ◽  
Limb Ischemia ◽  
Venous Access ◽  
Acute Limb Ischemia ◽  
Cone Snail ◽  
Coronary Insufficiency ◽  
Gradual Improvement ◽  
Harlequin Syndrome ◽  
Va Ecmo ◽  
The Right

We report the first VA-VAV-VV ECMO conversion in a 57-year-old Filipino female with persistent coronary insufficiency from toxic shock syndrome due to Streptococcus pyogenes bacteremia, acute respiratory distress syndrome, and Harlequin syndrome with progressive acute limb ischemia from cone snail venom poisoning. The patient came in via air ambulance transport because deteriorating clinical status after having stepped on a cone snail 3 days prior and developing severe dehydration from vomiting and passage of voluminous watery stools after eating a local delicacy. The patient was admitted at the ICU where after 3 days of treatment, the patient developed cardiac tamponade and underwent stat pleuropericardial windowing with pericardiocentesis. Due to increasing pressor requirements from the combined shock, Swan-Ganz catheterization was inserted and a VA-ECMO system was set up. There was gradual improvement in cardiac hemodynamics, however oxygen requirement was increasing and both lower extremities became progressively violaceous with decreasing pulses. Harlequin syndrome was ruled in, the multidisciplinary team decided to convert to VAV hybrid circuit by adding a venous access by way of the right internal jugular vein. Improvement in oxygenation lead to eventual conversion from VAV to purely VV dedicated circuit. Ultrafiltration via ECMO was likewise done because of worsening azotemia and oliguria. The patient was then gradually weaned off from ECMO and was successfully decannulated after 8 days. Below knee amputation was done to address the progressive acute limb ischemia. The patient was nutritionally built up and physically rehabilitated and was eventually discharged improved on the 28th hospital day.

scholarly journals Double Distal Perfusion Catheters for Severe Limb Ischemia on the IABP Side in Patients Who Received Femoro-Femoral VA-ECMO With IABP

2021 ◽  
Vol 8 ◽  
Author(s):  
Meng Xin ◽  
Liangshan Wang ◽  
Xiaqiu Tian ◽  
Dengbang Hou ◽  
Hong Wang ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Near Infrared ◽  
Limb Ischemia ◽  
Symptomatic Treatment ◽  
Acute Limb Ischemia ◽  
Membrane Oxygenation ◽  
Number Of Patients ◽  
Distal Perfusion ◽  
Va Ecmo ◽  
Postcardiotomy Cardiogenic Shock

Background: Limited research is available on the pattern of double distal perfusion catheters in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) with an intra-aortic balloon pump(IABP). Here, we compared the outcomes of a double distal perfusion catheter and conventional treatment in patients who received VA-ECMO with IABP and had severe lower limb ischemia on the IABP side.Methods: We reviewed the data of 15 adult patients with postcardiotomy cardiogenic shock who received VA-ECMO via femoral cannulation combined with an IABP in the contralateral artery that was complicated with severe acute limb ischemia (ALI) on the same side as the IABP between January 2004 and December 2016. Patients underwent symptomatic treatment (conventional group, n = 9) and double distal perfusion catheterization treatment (DDPC group, n = 6). ALI was monitored using near-infrared spectroscopy placed on both calves after double distal perfusion catheters. The outcomes were compared.Results: All 6 patients who underwent double distal perfusion catheters were successfully decannulated without the development of osteofascial compartment syndrome, amputation, or bleeding and infection of the double distal perfusion catheters. The number of patients who weaned from extracorporeal membrane oxygenation successfully in the DDPC and conventional groups was 6 (100%) and 3 (33%, p = 0.028), respectively. The in-hospital mortality rates were 17% and 89% for the DDPC and conventional groups, respectively (p = 0.011).Conclusions: DDPC can be considered a strategy for severe limb ischemia on the IABP side in patients who received femoro-femoral VA-ECMO with IABP.

scholarly journals Effect of Acute Limb Ischemia on the Mortality of Patients with Extracorporeal Membrane Oxygenation Established by Femoral Vein-Arterial Catheterization and Analysis of Related Risk Factors

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xiang Li ◽  
Guang Chen ◽  
Sheng Zhang ◽  
Xinting Zheng ◽  
Wenjun Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Risk Factor ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Cardiopulmonary Failure ◽  
Va Ecmo ◽  
Associated Risk Factors

Extracorporeal membrane oxygenation (ECMO) is a common treatment for cardiopulmonary failure. Although it can effectively reduce the mortality of patients with cardiopulmonary failure, it still has a high mortality rate, such as acute limb ischemia (ALI), stroke, liver and kidney failure, and other related complications and related causes of death. This study aims to explore the impact of ALI on the mortality of VA-ECMO patients in hospital and 6 months after discharge and analyze the occurrence of ALI and related factors that affect the mortality of VA-ECMO in hospital and 6 months after discharge. The results showed that the smoking history was an independent risk factor for ALI, and age, diabetes, cardiac arrest, first time of ECMO, and hyperbilirubinemia were associated risk factors for in-hospital mortality. Cardiac arrest and ALI were associated risk factors for mortality at 6 months after discharge. Although ALI is not significantly associated with VA-ECMO in-hospital mortality, it is a risk factor for mortality at 6 months after discharge, and medical personnel should therefore strive to reduce and avoid ALI.

Acute limb ischemia after femoral arterial closure with a vascular sealing device: Successful endovascular treatment

VASA ◽  
2004 ◽  
Vol 33 (4) ◽  
pp. 252-256 ◽  
Author(s):  
Schiele ◽  
Rademacher ◽  
Meissner ◽  
Klauss ◽  
Hoffmann
Keyword(s):  
Therapeutic Option ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Distal Embolization ◽  
Percutaneous Catheter ◽  
Percutaneous Coronary ◽  
The Right ◽  
Crural Arteries ◽  
Percutaneous Thrombectomy ◽  
Sealing Device

We report on successful catheter therapy of acute occlusions of popliteal and crural arteries due to distal embolization from a vascular sealing device. A 45 years-old male patient underwent percutaneous coronary angiography. After primary successful closure of the right femoral artery by a sealing device the patient developed acute ipsilateral lower limb ischemia, most probably due to embolization of a collagen/thrombin plug. Occlusions of the popliteal and crural vessels were successfully treated by percutaneous thrombectomy, thrombolysis and ballon angioplasty. Combined percutaneous catheter therapy is a therapeutic option for occlusions of popliteal and crural vessels due to embolization from a vascular sealing device.

scholarly journals Upper Limb Ischemia in Preterm Infant Leading to Autoamputation of Hand – a Case Report

2021 ◽  
pp. 253
Author(s):  
Keyword(s):  
Upper Limb ◽  
Color Doppler ◽  
Rare Condition ◽  
Ulnar Artery ◽  
Limb Ischemia ◽  
Feeding Tube ◽  
Acute Limb Ischemia ◽  
Infant Feeding Tube ◽  
Neonatal Icu ◽  
The Right

Acute limb ischemia(ALI) in a paediatric patient is a rare condition but may result in limb loss and life long complications. We present here a case of a 34 weeks premature infant, with birth weight 1530 grams, who was having respiratory distress at time of birth. Infant was referred to advanced pediatric center for further management, where he was kept in neonatal ICU. He was put on C-PAP and oxygen support and an infant feeding tube for feeding. On 21st day infant developed ischemia of the right upper limb. Color Doppler flow study was done which revealed thrombosed right radial and ulnar artery and biphasic flow in brachial artery. He was put on low molecular weight heparin and was advised referral to higher center for further management. Patient developed dry gangrene of right hand and wrist resulting in the autoamputation of the hand and wrist after a period of 15 day from development of gangrene. In order to prevent such complications there should well trained staff to detect early ischemic changes in the limb so that timely treatment can be started and the long term chronic complications can be prevented.

scholarly journals Cystic Adventitial Disease of the Common Femoral Artery: A Rare-Case Report

2022 ◽  
Vol 8 ◽  
Author(s):  
Qilong Wang ◽  
Zhihua Cheng ◽  
Liang Tang ◽  
Qi Wang ◽  
Ping Zhang ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Acute Limb Ischemia ◽  
Appropriate Treatment ◽  
Contrast Enhanced ◽  
Rare Case Report ◽  
The Right ◽  
Enhanced Computed Tomography

Herein, we report the case of a 59-year-old man with intermittent claudication of ~100 m, who complained of resting pain in his lower right extremity. A pelvic, contrast-enhanced, computed tomography scan showed the presence of cystic density in the lower segment of the right common femoral artery. Faced with the risk of acute limb ischemia, we navigated a challenging diagnostic procedure to choose an appropriate treatment for him. Additionally, we performed a pathological investigation of the excised common femoral artery following the excision bypass. On postoperative day 5, the patient was discharged from the hospital. During the 2-year follow-up, no new cysts were discovered, and the patient had favorable prognosis.

scholarly journals Acute vascular complications of femoral venoarterial ECMO; a single center retrospective study

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Laimoud ◽  
E Saad ◽  
S Koussayer
Keyword(s):  
Cardiogenic Shock ◽  
Vascular Complications ◽  
Limb Ischemia ◽  
Adult Patients ◽  
Acute Limb Ischemia ◽  
Care Hospital ◽  
Refractory Cardiogenic Shock ◽  
Cannulation Site ◽  
Significant Difference ◽  
Va Ecmo

Abstract Funding Acknowledgements Type of funding sources: None. Backgroud Emergent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to provide rapid cardiopulmonary resuscitation in adult patients with refractory cardiogenic shock . Femoral arterial cannulation may result in  ipsilateral limb ischemia due to  reduced distal  blood flow below the insertion point of the cannula .We retrospectively studied  adult patients supported with femoral VA-ECMO for cardiogenic shock between  2015 and 2019 at our tertiary care hospital.  Results : the study included 65 adult patients supported on femoral VA-ECMO  for refractory cardiogenic shock . The studied patients had  a mean age of 37.9 ± 14.87 years , mostly males (70.8%) , a mean  BSA of 1.77 ±0.27 m2 and a mean BMI of 26.1 ± 6.7 kg/m2 . Twenty one (32.3%) patients developed acute lower limb ischemia. Femoral thrombectomy and angioplasty were done in 20 (30.8% ) patients . Four  (6.2%) patients developed limb compartmental syndrome and fasciotomy was done . Amputation of toes was done in one patient . The vascular complications included cannulation site bleeding in 24.6% of patients ,  femoral arteriovenous fistula in one patient and  large pseudoaneurysm after ECMO decannulation and required vascular surgical repair . Three (4.6%) patients developed chronic limb ischemia manifestations after hospital discharge . The patients who developed acute  limb ischemia had significantly frequent AKI (<0.001) without significant use of haemodialysis (p = 0.07) and longer ICU stay (p = 0.028) compared to the patients without limb ischemia. The hospital mortality occurred in 29 (44.6%)  patients  without significant difference between the patients with and without acute limb ischemia.  The  occurrence of acute  limb ischemia was significantly  correlated with failed percutaneous femoral cannulation (p = 0.039 )  while there was no significant statistical correlation between the  cut-down technique and occurrence of limb ischemia(p = 0.053).  The occurrence of femoral cannulation site bleeding was significantly correlated with failed percutaneous cannulation (p = 0.001 ) and cut-down technique (p = 0.001) .  Conclusion :  Acute vascular complications are frequent after femoral VA-ECMO. Failed percutaneous femoral cannulation has been, in this study identified as the most important risk factor for acute limb ischemia and cannulation site bleeding. Recommendation: A careful approach during femoral cannulation is recommended to prevent occurrence of acute limb ischemia and femoral cannulation site bleeding. Abstract Figure. Cannulation approaches of VA-ECMO .

Thromboembolic (TE) complications in germ cell tumor (GCT) patients: Should use of peripherally inserted central catheters (PICC-Line) be pursued?

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 571-571
Author(s):  
Louis Francois ◽  
Marine Gross-Goupil ◽  
Gregoire Robert ◽  
Alain Ravaud
Keyword(s):  
Median Time ◽  
Univariate Analysis ◽  
Limb Ischemia ◽  
Venous Access ◽  
Tumor Stage ◽  
University Hospital ◽  
Acute Limb Ischemia ◽  
Access Port ◽  
Picc Line ◽  
Venous Access Port

571 Background: Patients with GCT receiving cisplatin-based chemotherapy are at high risk of TE events (TEE). Several risk factors have been reported previously, such as cisplatin, Lactate Deshydrogenase, body surf area (BSA)... Methods: we conducted a retrospective study of all patients (pts) with GCT, treated with platinum salts and followed at the university hospital and anticancer center of Bordeaux (June 2007 - January 2015). The following characteristics were recorded: age, performans status, BSA, histological type, site of primitive tumor, stage, prognosis (IGCCCG classification), size of retroperitoneal lymphnode, LDH, type of venous pathway (peripheral vein, implantable venous access port or PICC-Line), prophylaxis of anticoagulant or not, TEE and median time to onset. Results: 206 pts were selected. Thirty-six (17.4%) had one or more venous or arterial TEE during or within 3 months of the end of chemotherapy: 26 deep vein thromboses, 13 pulmonary embolisms and 4 arterial accidents (2 acute limb ischemia and 2 acute coronary syndromes). The median time between treatment initiation and occurrence of TEE was 38.5 days [7-248]. Among the 12 pts with PICC-line, 6 (50%) had a TEE, including 4 cases of pulmonary embolism. In addition to the presence of a PICC-line (OR 4.62 [1.28, 15.56]), factors associated with an increased TE risk in univariate analysis were the use of implantable venous access port (OR: 3.97 [1.81; 9.12]), size of retroperitoneal adenopathy ≥ 2 cm ([2-5 cm]: OR: 24.39 [4.50 - 454.39]; > 5cm : OR : 26.25 [5,00 - 484.5]), stage II (OR : 10.19 [1,9 - 188.96]), stage III (OR :27.2 [5.34 - 479.9]), prognosis group (good : OR : 11.16 [2.16 - 205.04]) ; intermediate : OR : 31.50 [4.81 – 624.20] ; unfavorable : OR : 33.35 [5.7 – 637.34]), VIP (etoposide-ifosfamide-cisplatin) protocol (OR :6.35 [1.51 – 28.15]) and high LDH level (OR :3.88 [1.63 – 10.34]). Conclusions: These results suggest a significant association between PICC-line and the occurrence of TEE in univariate analysis. PICC-line is not risk-free and should be used sparingly in pts with GCT whose treatment objective remains primarily a cure at the cost of less toxicity.

scholarly journals Acute vascular complications of femoral veno-arterial ECMO: a single-centre retrospective study

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Mohamed Laimoud ◽  
Elias Saad ◽  
Samer Koussayer
Keyword(s):  
Cardiogenic Shock ◽  
Vascular Complications ◽  
Limb Ischemia ◽  
Adult Patients ◽  
Acute Limb Ischemia ◽  
Care Hospital ◽  
Cannulation Site ◽  
Significant Difference ◽  
Percutaneous Cannulation ◽  
Va Ecmo

Abstract Background Femoral arterial cannulation to initiate veno-arterial ECMO may result in ipsilateral limb ischemia due to reduced distal blood flow below the insertion point of the cannula. We retrospectively studied adult patients supported with femoral VA-ECMO for cardiogenic shock between 2015 and 2019 at our tertiary care hospital. Results The study included 65 adult patients supported with femoral VA-ECMO for refractory cardiogenic shock. The studied patients had a mean age of 37.9 ± 14.87 years, mostly males (70.8%), a mean BSA of 1.77 ± 0.27 m2, and a mean BMI of 26.1 ± 6.7 kg/m2. Twenty-one (32.3%) patients developed acute lower limb ischemia. The patients who developed acute limb ischemia had significantly frequent AKI (< 0.001) without significant use of haemodialysis (p = 0.07) and longer ICU stay (p = 0.028) compared to the patients without limb ischemia. The hospital mortality occurred in 29 (44.6%) patients without significant difference between the patients with and without acute limb ischemia. The occurrence of acute limb ischemia was significantly correlated with failed percutaneous cannulation (p = 0.039), while there was no significant statistical correlation between the cut-down technique and occurrence of limb ischemia (p = 0.053). The occurrence of femoral cannulation site bleeding was significantly correlated with failed percutaneous cannulation (p = 0.001) and cut-down technique (p = 0.001). Conclusion Acute vascular complications are frequent after femoral VA-ECMO. Failed percutaneous femoral cannulation has been, in this study, identified as the most important risk factor for acute limb ischemia and cannulation site bleeding. A careful approach during femoral cannulation is recommended to prevent occurrence of acute limb ischemia and femoral cannulation site bleeding.

Managing Harlequin Syndrome in VA-ECMO – do not forget the right ventricle

Perfusion ◽  
2021 ◽  
pp. 026765912110208
Author(s):  
James Wilson ◽  
Richard Fisher ◽  
Francisca Caetano ◽  
Hatem Soliman-Aboumarie ◽  
Brijesh Patel ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Extracorporeal Membrane Oxygenation ◽  
Right Ventricle ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Ecmo Circuit ◽  
Harlequin Syndrome ◽  
Va Ecmo ◽  
The Right

Harlequin Syndrome (also known as North-South Syndrome) is a complication of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) that can occur when left ventricular function starts to recover. While most commonly due to continued impaired gas exchange in the lungs, we present a case caused by right ventricular dysfunction, successfully managed by conversion of the ECMO circuit to a veno-veno-arterial (VV-A) configuration.

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