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Walid Gharzuddine - 2016-04-27


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Answer to what is your diagnosis
 
Published on 2015-04-19 by Walid Gharzuddine
 
 
History and Findings
 

As mentioned in the history the patient was severely hypoxemic requiring extra-ordinary measures to maintain oxygenation. Unusual color flow was noted in the right atrium by Echocardiography.

This extraordinary method was instititution of VENO-VENOUS EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO). This entailed placing two catheters, one in the inferior vena cava via the femoral vein that removes blood and the other in via the internal jugular vein to return the blood to the right atrium. The jet of blood from this superior vena caval catheter was the cause of the continuous color flow in the right atrium seen on the echo videos....The tip of the catheter is seen in the roof of the right atrium on the apical and sucostal views.

 
 
 
 
 
 
Discussion
 

Extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) is a technique of providing both cardiac and respiratory support to patients whose heart and lungs are unable to provide an adequate amount of gas exchange to sustain life. This intervention has mostly been used on pediatric patients, but it is seeing more use in adult patients with cardiac and respiratory failure. ECMO works to remove the carbon dioxide from the blood and oxygenate it. Generally it is only used in the later treatment of a person with heart or lung failure as it is solely a life-sustaining intervention.

Two modes are available: veno-arterial and veno-venous.

In veno-arterial ECMO – a venous cannula is usually placed in the right common femoral vein for extraction and an arterial cannula is usually placed into the right femoral artery for infusion. Central VA ECMO may be used if cardiopulmonary bypass has already been established (with cannulae in the right atrium and ascending aorta)

Veno-venous (VV)

In veno-venous ECMO cannulae are usually placed in the right common femoral vein for drainage and right internal jugular vein for infusion. Alternatively, a dual lumen catheter is inserted into the right internal jugular vein, draining blood from the superior and inferior vena cavae and returning it to the right atrium. This is used in respiratory failure.

Outcomes

With acute respiratory failure use of ECMO has been shown to improve survival rates. Survival rates from 50—70 percent have been reported in observational and uncontrolled clinical trials. The survival rates reported are better than historical survival rates.

Guidelines that describe the indications and practice of ECMO are published by the Extracorporeal Life Support Organization (ELSO). Criteria for the initiation of ECMO include acute severe cardiac or pulmonary failure that is potentially reversible and unresponsive to conventional management.

Examples of clinical situations that may prompt the initiation of ECMO include the following:

•    Hypoxemic respiratory failure with a ratio of arterial oxygen tension to fraction of inspired oxygen (PaO2/FiO2) of <100 mmHg despite optimization of the ventilator settings, including the Fraction of Inspired Oxygen (FiO2), positive end-expiratory pressure (PEEP), and inspiratory to expiratory (I:E) ratio.

•    Hypercapnic respiratory failure with an arterial pH <7.20.

•    Refractory cardiogenic shock.

•    Cardiac arrest.

•    Failure to wean from cardiopulmonary bypass after cardiac surgery.

•    As a bridge to either cardiac transplantation or placement of a ventricular assist device.

 

I hope you enjoyed the challenege of this unusual sighting which may not be seen except in advanced care centers.

Special thanks to Dr. Elie Chammas who was the only person willing to venture and suggest an explanation.... 

Walid Gharzuddine

 
Latest Comments
 
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chnloveMax reply on 2017-06-12
 
specified includes predispose those to be able to heated sign since the evening to sweat behaviors PITTSBURGH, July 13, 2016 many women will have menopausal flashes or a sweating chnlove review at some stage in life. on the flip side, whenever you are these symptoms exist and just how long individuals remain serviceable varies considerably among female. emerging findings clearly show that girls fit four major types in the event of getting menopausal flashes since night sweats, by means of new outcome to obtain treatment as well as,while protection against future medical conditions, based on the research directed through or even of all Pittsburgh move on schooling public court your well-being. The epidemiological researching acquired regarding women for typically 15 a few years diagnosed functions which experts state likely to be able them to certain trajectories when getting menopausal flashes and night sweats jointly acknowledged "Vasomotor your body's symptoms, the entire conclusions really are revealed nowadays in this disorder to do with climacteric: The log of the north american climacteric people as well as,while were actually financed by the nation's institutes of medical. "now that we know that these symptoms remain for a lot lengthy in most cases seven to 10 a number of occur at different occasions when a variety of brides. genuinely is potent substantiation that discovered further study the main physical reasons for vasomotor manifestations and as well as certain check out essentially preventable diseases, hot flashes and night sweats demand intense do away with along with feverish hot temperature and so are associated with climacteric, the moment when a lady's monthly interval stops. doctor. Thurston as well your loved one peers tried 1,455 women enrolled in study regarding womens body within the chnlove.Com Nation (SWAN) so, who had not yet completed the symptoms of menopause evaluations enrollment. all the year, the women claimed as well as her vasomotor conditions, properly finding a scientific review but a lot of times a retain test. they came upon that the ladies maybe to some degree just broken into four particular trajectories for vasomotor indications or symptoms because had menopause move, And that particular components are already prevalent in kinds: A routinely minimal possibility of having situation within menopause adaptation ended up being usual in far eastern girls. A solidly raised chance of having anxiety within your conversion would be more widespread in ebenholzfarben moms, individuals with a smaller amount of tutoring, those who announced alcohol consumption without excess or heavily, and people who described warning signs of gloominess or anxiety. a young start disorders within the decade until the final circuit when it comes to cessation thereafter appears to be more widespread among girls that were obesity, achieved indication of natural depression or perhaps even anxieties, seemed to be living in not as good diet-related in comparison with his or her's mates and much later at change of life. A long left undone onset of indicators and following final point in time your little-by-little turned down in suggestions decade could be more common in women with a lower bmi (proportion on unwanted weight so that you can level), visitors who cigarette or black and white those. junk food diet variations were correlated because of vasomotor effects but rather cant be found absolutely unfailing, specifying that they did not fully are the cause of the telltale signs. "when you see signs this way, It points too there's something coming about more menopausal flashes and as well,as well as the sweating a passing pest. determined by which grouping girls crumbles to be able to, you can find important effects focused on her genuine health, In distinctive, late exploration, medical professional. Thurston considered confirmation that do some of these trajectories happen to be included in jeopardize aspects on behalf of heart disease. "at that time, we can't completely untangle any causal liaison relating vasomotor indicators and symptoms and after that healthy good results or would suggest deterrent dimensions ChnLove REAL OR FAKE during vasomotor when not having longer questionnaire, agreed dr. Thurston. SWAN carries grants boost about NIH through the national company on age, the national start of nursing jobs query and your job of women's on vigor (permits U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, additionally U01AG012495).
 
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