CT pulmonary angiography during veno‐arterial extracorporeal membrane oxygenation in an adult

Abstract

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) causes changes in the filling and blood flow of the cardiac chambers and pulmonary vessels as well as alterations in the path of intravenous contrast injected during CT. We present a patient with a potentially misleading CT pulmonary angiogram while on full VA ECMO. We demonstrate circulatory changes as well as alterations in contrast flow when ECMO flows are reduced.

Extrakorporale Membranoxygenierung bei Erwachsenen – Varianten, Komplikationen unter Therapie und die Rolle der radiologischen Diagnostik

“…1). Alternatively, it is possible to use a double lumen cannula (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) that is positioned through the internal jugular vein and the right atrium with the tip in the inferior vena cava [6,12,13,16,17].…”

“…To avoid the uncertainties of contrast agent timing, additional use of a bolus tracking mechanism in the body region to be examined is possible. However, the start of a possibly necessary manual examination in the event that the previously defined threshold value is not reached must be factored in [11,14,25,26].…”

Building a Bridge to Save a Failing Ventricle: Radiologic Evaluation of Short- and Long-term Cardiac Assist Devices

“…As the left ventricle is bypassed with venoarterial ECMO and oxygenated blood is returned from the arterial cannula, there is retrograde blood flow in the ascending aorta and stasis of blood in the left ventricle; this situation can predispose a patient to cardiac thrombosis. Coronary or cerebral hypoxia can result with venoarterial ECMO because of differential cyanosis, which occurs when left ventricular function is recovered while lung function remains impaired (17). Local complications at the cannulation site can also occur with venoarterial ECMO and may lead to limb ischemia (Fig 9) (18).…”

“…(Reprinted with permission from Cleveland Clinic Center for Medical Art & Photography, Cleveland, Ohio.) patterns at contrast-enhanced CT, such as small pulmonary arteries and nonopacification of the left-sided chambers and ascending thoracic aorta with dense opacification of the descending thoracic aorta (Fig 11) (17,19). These patterns are commonly seen with full flow settings (19).…”

“…The Thoratec VAD is a pneumatically operated first-generation VAD that is commercially available in both paracorporeal and intracorporeal models (17). Both models can be used to provide either univentricular or biventricular support.…”