Cardiac tamponade in venoarterial extracorporeal membrane oxygenation

Morcos, Michael; Vincent, Logan; Harari, Rafael; Badulak, Jenelle; Chen, Michael

doi:10.1111/echo.15145

Cited by 4 publications

(5 citation statements)

References 7 publications

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“…Recognizing cardiac tamponade in ECMO patients is challenging, as the characteristic signs are less specific, less pronounced or completely absent during ECMO [ 2 ]. The classically noted muffled heart sounds and diminished pulses are also seen with VA ECMO, as the heart is relatively empty with diminished pulsatility.…”

Section: Discussionmentioning

confidence: 99%

“…While pericardiocentesis is effective, surgical drainage with pericardial window is warranted in suspected cardiovascular injury, with extension to sternotomy if hemopericardium or obvious injury is confirmed. Most cases of ECMO cannulation complicated by tamponade involve hemopericardium with a few serous effusions reported [ 2 , 3 ]. To our knowledge, this is the first case reported of a milky pericardial effusion causing tamponade in a neonate following ECMO cannulation.…”

Section: Discussionmentioning

confidence: 99%

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Milky pericardial effusion causing tamponade in a neonate after extracorporeal membrane oxygenation cannulation

Thornhill,

Fortuna,

Canteras

et al. 2023

Journal of Surgical Case Reports

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Cardiac tamponade is a known life-threatening complication of extracorporeal membrane oxygenation (ECMO), often secondary to hemopericardium from major vascular or cardiac perforation. We present the unique case of a neonate with a milky pericardial effusion causing tamponade after ECMO cannulation, managed successfully with pericardial window. Understanding ECMO physiology and its effect on the classic presentation of tamponade is critical and can prevent delays in diagnosis. While hemopericardium is most commonly seen in these cases, findings of a non-bloody, milky effusion should prompt further workup for infection, chylopericardium or total parenteral nutrition-associated pericardial effusion, as the appropriate management can mitigate immediate and potential long-term sequelae.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Milky pericardial effusion causing tamponade in a neonate after extracorporeal membrane oxygenation cannulation

Thornhill,

Fortuna,

Canteras

et al. 2023

Journal of Surgical Case Reports

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“…Although ECMO is a feasible treatment for cardiac arrest, ECMO for cardiac tamponade has two potential problems. First, elevated pericardial pressure may lead to suction events and decreased ECMO flow in the event of cardiac tamponade [ 6 ]. Moreover, cardiac tamponade induced right atrial collapse, resulting in venous congestion at the inferior vena cava (IVC) or SVC, whichever was not canulated.…”

Section: Discussionmentioning

confidence: 99%

Peripheral VA-ECMO and pericardial drainage connected to the ECMO circuit for cardiac tamponade from blowout rupture: a case report

Kato,

Miyagawa,

Hikone

et al. 2023

BMC Cardiovasc Disord

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Background Left ventricular free wall rupture, particularly the blowout type, is still one of the most lethal complications of myocardial infarction and can cause catastrophic cardiac tamponade. Extracorporeal membrane oxygenation (ECMO) is often used to treat haemodynamic instability due to cardiac tamponade. However, elevated pericardial pressure can cause collapse of the right atrium, resulting in inadequate ECMO inflow and preventing the stabilisation of the circulation. Further, it can interfere with the venous return from the superior vena cava (SVC), increasing the intracranial pressure and reducing cerebral perfusion levels. Case presentation A 65-year-old man was hospitalised for out-of-hospital cardiac arrest. We used ECMO for cardiopulmonary resuscitation. After the establishment of ECMO, transthoracic echocardiography and left ventriculography revealed massive pericardial effusion. The treatment was supplemented with pericardial drainage since ECMO flow was frequently hampered by suction events. However, the blowout rupture led to the requirement of constant drainage from the pericardial catheter. To tend to this leak, we connected the venous cannula of ECMO and the pericardial drainage catheter. The surgery was performed with stable circulation without suction failure of ECMO. During the course of the intensive care management, the neurological prognosis of the patient was revealed to be poor, and the patient was shifted to palliative care. Unfortunately, the patient died on day 10 of hospitalisation. Conclusion We present a case wherein the combination of pericardial drainage and ECMO was used to maintain circulation in a patient with massive pericardial effusion due to cardiac rupture.

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“…Da sowohl der PVAD als auch die IABP auf eine ausreichende rechtsventrikuläre Funktion angewiesen sind (die beim obstruktiven Schock nicht vorliegt), stellen diese MCS für den obstruktiven Schock meist keine Therapieoption dar. Die VA-ECMO kann bei Herzbeuteltamponade [50,51] oder Lungenarterienembolie zum Einsatz kommen [52,53].…”

Section: Obstruktiver Schockunclassified

Mechanische Kreislaufunterstützung im Schock

Rottmann,

Michels,

Wengenmayer

et al. 2023

Aktuelle Kardiologie

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ZusammenfassungMechanische Kreislaufunterstützungssysteme (engl. Mechanical Circulatory Support, MCS) haben in den letzten Jahren eine zunehmende Bedeutung in der akutmedizinischen Therapie des kritisch kranken Patienten im Schock erlangt. Aktuell stehen in Europa verschiede Systeme zur Verfügung, die sich in Wirkweise und Einsatzgebiet signifikant unterscheiden. Neben den MCS-Charakteristika und der Zentrumsexpertise sind aber auch Patientencharakteristika für die Auswahl des richtigen MCS zu beachten. Unterschiedliche Schockformen fordern eine differenzierte Therapie, je nach Ätiologie des Schocks und seiner hämodynamischen Akzentuierung (so braucht z. B. ein infarktbedingter kardiogener Schock mit führendem Linksherzversagen eine andere Therapie als ein infarktbedingter kardiogener Schock mit führendem Rechtsherzversagen). Die Auswahl des jeweiligen Herzunterstützungssystems richtet sich nach der Pathophysiologie der zugrunde liegenden Erkrankung. Bisweilen sind Kombinationen von mehreren Unterstützungssystemen erforderlich. Dieser Übersichtsartikel diskutiert die verschiedenen Systeme (extrakorporale Membranoxygenierung, intraaortale Ballonpumpe, Mikroaxillarpumpe/perkutanes linksventrikuläres Unterstützungssystem, perkutanes rechtsventrikuläres Unterstützungssystem) und deren Einsatzmöglichkeit im Kontext der verschiedenen Schockformen.

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Cardiac tamponade in venoarterial extracorporeal membrane oxygenation

Cited by 4 publications

References 7 publications

Milky pericardial effusion causing tamponade in a neonate after extracorporeal membrane oxygenation cannulation

Milky pericardial effusion causing tamponade in a neonate after extracorporeal membrane oxygenation cannulation

Peripheral VA-ECMO and pericardial drainage connected to the ECMO circuit for cardiac tamponade from blowout rupture: a case report

Mechanische Kreislaufunterstützung im Schock

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