Cardiac tamponade during venoarterial extracorporeal membrane oxygenation: a case report

Abstract

Background Cardiac tamponade may present with very different signs and clinical consequences in patients who are supported with venoarterial extracorporeal membrane oxygenation. Failure to recognize cardiac tamponade in this setting can cause failure to wean from venoarterial extracorporeal membrane oxygenation, and even lead to death. Case presentation We present a 44-year-old Caucasian female in whom cardiac tamponade manifested as venoarterial extracorporeal membrane oxygenation weaning failure. After discovering the contribution of cardiac tamponade, it was possible to wean the patient from venoarterial extracorporeal membrane oxygenation support. No clear signs of cardiac tamponade had existed beforehand. Conclusions The diagnosis of cardiac tamponade can be very challenging in venoarterial extracorporeal membrane oxygenation supported patients due to (patho)physiological particularities related to the parallel blood flow.

The physiology of venoarterial extracorporeal membrane oxygenation - A comprehensive clinical perspective

“…19,30 Such detailed clinical assessment should also include the differential diagnosis of cardiac tamponade, particularly in cases when weaning is difficult or poorly understood as classical clinical signs of tamponade may not be present during VA ECMO due to the influences of patient-device interaction on hemodynamics. 30,31 Optimal monitoring and management of cardio-pulmonary function and condition When high extracorporeal blood flow rates (>4 L/min; 60-80 mL/kg) are required to maintain adequate organ perfusion, 32 it should be realized that pulmonary artery blood flow may significantly decrease. 33 This may potentially cause ischemia of the native lung.…”

“… 19 , 30 Such detailed clinical assessment should also include the differential diagnosis of cardiac tamponade, particularly in cases when weaning is difficult or poorly understood as classical clinical signs of tamponade may not be present during VA ECMO due to the influences of patient-device interaction on hemodynamics. 30 , 31 …”