Optimizing Contrast-Enhanced Thoracoabdominal CT in Patients During Extracorporeal Membrane Oxygenation

Lidegran, Marika; Murkes, Lena Gordon; Lindholm, Jonas Andersson; Frenckner, Björn

doi:10.1016/j.acra.2020.01.029

Cited by 9 publications

(5 citation statements)

References 16 publications

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“…Common strategies to mitigate the effects of ECMO include temporary cessation or slowing of the ECMO flow, direct injection of contrast material into the ECMO outflow zone, and increased delay periods[ 14 ]. These strategies are used to manipulate the location of a watershed region, change the order of contrast enhancement, and use blood recirculation to deliver contrast to the area to be examined.…”

Section: Discussionmentioning

confidence: 99%

Cerebral pseudoinfarction due to venoarterial extracorporeal membrane oxygenation: A case report

Xu,

Yan,

Jin

et al. 2024

World J Clin Cases

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BACKGROUND Neurological complications are common in the management of venoarterial extracorporeal membrane oxygenation (VA-ECMO), with most patients requiring sedation and intubation, limiting the assessment of neurological function. There-fore, we must rely on advanced neuroimaging techniques, such as computed tomography angiography (CTA) and computed tomography perfusion (CTP). Because ECMO changes the normal blood flow pattern, it may interfere with the contrast medium in some special cases, leading to artifacts and ultimately mis-leading clinical decisions. CASE SUMMARY A 61-year-old man presented to a local hospital with chest tightness and pain 1 d prior to presentation. The patient was treated with VA-ECMO after sudden car-diac and respiratory arrest at a local hospital. For further treatment, the patient was transferred to our hospital. The initial consciousness assessment was not clear, and routine CTP was performed to understand the intracranial changes, which suggested a large area of cerebral infarction on the right side; however, the cerebral oxygen was not consistent with the CTP results, and the reexamination of CTA still suggested a right cerebral infarction. To identify this difference, bedside transcranial Doppler was performed, and the blood flow on both sides was different. By reducing the ECMO flow, CTP reexamination showed that the results were normal and consistent with the clinical results. On day 3, the patient was alert and showed good limb movements. CONCLUSION In patients with peripheral VA-ECMO, cerebral perfusion confirmed by CTP and CTA may lead to false cerebral infarction.

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Section: Discussionmentioning

confidence: 99%

Cerebral pseudoinfarction due to venoarterial extracorporeal membrane oxygenation: A case report

Xu,

Yan,

Jin

et al. 2024

World J Clin Cases

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“…Standard contrast doses were used: 2 mL/kg (maximum dose 120 mL) Visipaque at 320 mg I/mL. A previously published protocol for contrast administration adapted to the patient's specific ECMO circulation was followed (12).…”

Section: Computed Tomography Examinationsmentioning

confidence: 99%

“…However, these assessments often include information from other investigations such as computed tomography (CT) [11]. Today, CT is often used to evaluate lung recruitability and lung pathology [12,13]. A conventional CT scan can assist in the assessment of the amount of aerated lung but can have difficulties visualizing details of a consolidated lung.…”

Section: Introductionmentioning

confidence: 99%

Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation

Falk,

Lidegran,

Diaz Ruiz

et al. 2024

JCM

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Background: Extracorporeal membrane oxygenation (ECMO) is indicated for patients with severe respiratory and/or circulatory failure. The standard technique to visualize the extent of pulmonary damage during ECMO is computed tomography (CT). Purpose: This single-center, retrospective study investigated whether pulmonary blood flow (PBF) measured with echocardiography can assist in assessing the extent of pulmonary damage and whether echocardiography and CT findings are associated with patient outcomes. Methods: All patients (>15 years) commenced on ECMO between 2011 and 2017 with septic shock of pulmonary origin and a treatment time >28 days were screened. Of 277 eligible patients, 9 were identified where both CT and echocardiography had been consecutively performed. Results: CT failed to indicate any differences in viable lung parenchyma within or between survivors and non-survivors at any time during ECMO treatment. Upon initiation of ECMO, the survivors (n = 5) and non-survivors (n = 4) had similar PBF. During a full course of ECMO support, survivors showed no change in PBF (3.8 ± 2.1 at ECMO start vs. 7.9 ± 4.3 L/min, p = 0.12), whereas non-survivors significantly deteriorated in PBF from 3.5 ± 1.0 to 1.0 ± 1.1 L/min (p = 0.029). Tidal volumes were significantly lower over time among the non-survivors, p = 0.047. Conclusions: In prolonged ECMO for pulmonary septic shock, CT was not found to be effective for the evaluation of pulmonary viability or recovery. This hypothesis-generating investigation supports echocardiography as a tool to predict pulmonary recovery via the assessment of PBF at the early to later stages of ECMO support.

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“…However, some cases of ICH have been found by accident on brain imaging, which was performed along with thoracic/abdominal imaging or systematic screening. Lidegran et al reported that 67% of the ICH cases were diagnosed within the first 4 days of ECMO support ( 19 ). Although some measures were taken according to the state of the patients after confirming ICH, the percentages of patients on VA-ECMO and VV-ECMO who experienced ICH and survived till discharge were only 11% and 26%, respectively, according to the Extracorporeal Life Support Organization registry ( 1 ).…”

Section: Bleeding Complications Related To Ecmomentioning

confidence: 99%

Shear-induced acquired von Willebrand syndrome: an accomplice of bleeding events in adults on extracorporeal membrane oxygenation support

Wang

Chen

et al. 2023

Front. Cardiovasc. Med.

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Extracorporeal membrane oxygenation (ECMO) is an increasingly acceptable life-saving mechanical assistance system that provides cardiac and/or respiratory support for several reversible or treatable diseases. Despite important advances in technology and clinical management, bleeding remains a significant and common complication associated with increased morbidity and mortality. Some studies suggest that acquired von Willebrand syndrome (AVWS) is one of the etiologies of bleeding. It is caused by shear-induced deficiency of von Willebrand factor (VWF). VWF is an important glycoprotein for hemostasis that acts as a linker at sites of vascular injury for platelet adhesion and aggregation under high shear stress. AVWS can usually be diagnosed within 24 h after initiation of ECMO and is always reversible after explantation. Nonetheless, the main mechanism for the defect in the VWF multimers under ECMO support and the association between AVWS and bleeding complications remains unknown. In this review, we specifically discuss the loss of VWF caused by shear induction in the context of ECMO support as well as the current diagnostic and management strategies for AVWS.

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Optimizing Contrast-Enhanced Thoracoabdominal CT in Patients During Extracorporeal Membrane Oxygenation

Cited by 9 publications

References 16 publications

Cerebral pseudoinfarction due to venoarterial extracorporeal membrane oxygenation: A case report

Cerebral pseudoinfarction due to venoarterial extracorporeal membrane oxygenation: A case report

Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation

Shear-induced acquired von Willebrand syndrome: an accomplice of bleeding events in adults on extracorporeal membrane oxygenation support

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