Computed tomography pulmonary angiogram in a poly-trauma patient undergoing veno venous extracorporeal membrane oxygenation: our experience in diagnosing pulmonary embolism
Abstract Extracorporeal membrane oxygenation (ECMO) is an adapted form of the heart–lung machine that provides cardiopulmonary bypass life support for critically ill patients with acute cardiac and/or respiratory failure who are unresponsive to standard medical and surgical therapies. Although ECMO...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-09-01
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| Series: | The Egyptian Journal of Bronchology |
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| Online Access: | https://doi.org/10.1186/s43168-023-00227-0 |
| _version_ | 1797453634678554624 |
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| author | Ali Al Bshabshe Senthil Purushothaman Nasser Mohammed Alwadai Hussam Haider Omer Om Prakash Palanivel |
| author_facet | Ali Al Bshabshe Senthil Purushothaman Nasser Mohammed Alwadai Hussam Haider Omer Om Prakash Palanivel |
| author_sort | Ali Al Bshabshe |
| collection | DOAJ |
| description | Abstract Extracorporeal membrane oxygenation (ECMO) is an adapted form of the heart–lung machine that provides cardiopulmonary bypass life support for critically ill patients with acute cardiac and/or respiratory failure who are unresponsive to standard medical and surgical therapies. Although ECMO therapy has advanced significantly, complications like thrombosis and bleeding continue to be substantial, necessitating rapid transport of patients to the radiology suite to reveal crucial findings for further treatment plans or care. Even though the low flow rate for veno-arterial ECMO (VA-ECMO) support during contrast-enhanced CT is well known, the flow rate for veno-venous ECMO support during CT, especially computed tomography pulmonary angiography, is not well understood. Our case emphasizes that CTPA can be performed safely in trauma patients with ECMO runs and any suspected complications during ECMO runs may delay or worsen the clinical prognosis therefore immediate radiological verdicts may reveal significant findings to plan the treatment accordingly. Also, there were no complications associated with our examinations or transport. Our case highlights that VV-ECMO like VA-ECMO induces flow-dependent alterations in the patient’s circulation due to contrast injections, which might lead to an incorrect interpretation of CTPA. However, CTPA is safe, and bringing down the VV-ECMO flow rate of zero with vigilant monitoring of vitals and ventilation support helps radiologists to predict and interpret the contrast flow based on injection and cannula sites in the diagnosing and evaluation of pulmonary embolism patients with acute respiratory failure during ECMO. |
| first_indexed | 2024-03-09T15:25:40Z |
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| id | doaj.art-c8e0d14824bb4b2ea50548ce5a3bf9f6 |
| institution | Directory Open Access Journal |
| issn | 2314-8551 |
| language | English |
| last_indexed | 2024-03-09T15:25:40Z |
| publishDate | 2023-09-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Egyptian Journal of Bronchology |
| spelling | doaj.art-c8e0d14824bb4b2ea50548ce5a3bf9f62023-11-26T12:33:48ZengSpringerOpenThe Egyptian Journal of Bronchology2314-85512023-09-011711610.1186/s43168-023-00227-0Computed tomography pulmonary angiogram in a poly-trauma patient undergoing veno venous extracorporeal membrane oxygenation: our experience in diagnosing pulmonary embolismAli Al Bshabshe0Senthil Purushothaman1Nasser Mohammed Alwadai2Hussam Haider Omer3Om Prakash Palanivel4Department of Medicine/Adult Critical Care, Aseer Central Hospital, King Khalid UniversityChettinad School of Physiotherapy, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE)Department of Respiratory Therapy, Critical Care Unit, Aseer Central HospitalDepartment of Critical Care Unit, Aseer Central HospitalChettinad School of Physiotherapy, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE)Abstract Extracorporeal membrane oxygenation (ECMO) is an adapted form of the heart–lung machine that provides cardiopulmonary bypass life support for critically ill patients with acute cardiac and/or respiratory failure who are unresponsive to standard medical and surgical therapies. Although ECMO therapy has advanced significantly, complications like thrombosis and bleeding continue to be substantial, necessitating rapid transport of patients to the radiology suite to reveal crucial findings for further treatment plans or care. Even though the low flow rate for veno-arterial ECMO (VA-ECMO) support during contrast-enhanced CT is well known, the flow rate for veno-venous ECMO support during CT, especially computed tomography pulmonary angiography, is not well understood. Our case emphasizes that CTPA can be performed safely in trauma patients with ECMO runs and any suspected complications during ECMO runs may delay or worsen the clinical prognosis therefore immediate radiological verdicts may reveal significant findings to plan the treatment accordingly. Also, there were no complications associated with our examinations or transport. Our case highlights that VV-ECMO like VA-ECMO induces flow-dependent alterations in the patient’s circulation due to contrast injections, which might lead to an incorrect interpretation of CTPA. However, CTPA is safe, and bringing down the VV-ECMO flow rate of zero with vigilant monitoring of vitals and ventilation support helps radiologists to predict and interpret the contrast flow based on injection and cannula sites in the diagnosing and evaluation of pulmonary embolism patients with acute respiratory failure during ECMO.https://doi.org/10.1186/s43168-023-00227-0Acute respiratory distress syndromePulmonary embolismVeno-veno extracorporeal membrane oxygenationComputed tomography pulmonary angiogramTrauma |
| spellingShingle | Ali Al Bshabshe Senthil Purushothaman Nasser Mohammed Alwadai Hussam Haider Omer Om Prakash Palanivel Computed tomography pulmonary angiogram in a poly-trauma patient undergoing veno venous extracorporeal membrane oxygenation: our experience in diagnosing pulmonary embolism The Egyptian Journal of Bronchology Acute respiratory distress syndrome Pulmonary embolism Veno-veno extracorporeal membrane oxygenation Computed tomography pulmonary angiogram Trauma |
| title | Computed tomography pulmonary angiogram in a poly-trauma patient undergoing veno venous extracorporeal membrane oxygenation: our experience in diagnosing pulmonary embolism |
| title_full | Computed tomography pulmonary angiogram in a poly-trauma patient undergoing veno venous extracorporeal membrane oxygenation: our experience in diagnosing pulmonary embolism |
| title_fullStr | Computed tomography pulmonary angiogram in a poly-trauma patient undergoing veno venous extracorporeal membrane oxygenation: our experience in diagnosing pulmonary embolism |
| title_full_unstemmed | Computed tomography pulmonary angiogram in a poly-trauma patient undergoing veno venous extracorporeal membrane oxygenation: our experience in diagnosing pulmonary embolism |
| title_short | Computed tomography pulmonary angiogram in a poly-trauma patient undergoing veno venous extracorporeal membrane oxygenation: our experience in diagnosing pulmonary embolism |
| title_sort | computed tomography pulmonary angiogram in a poly trauma patient undergoing veno venous extracorporeal membrane oxygenation our experience in diagnosing pulmonary embolism |
| topic | Acute respiratory distress syndrome Pulmonary embolism Veno-veno extracorporeal membrane oxygenation Computed tomography pulmonary angiogram Trauma |
| url | https://doi.org/10.1186/s43168-023-00227-0 |
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