Hidden Harlequin syndrome in neonatal and pediatric VA-ECMO

• Published in: Critical care (London, England) Vol. 26; no. 1; p. 146
• Main Authors: Levy, Yael, Starck, Julie, Mary, Anne-Lise, Soreze, Yohan, Jean, Sandrine, Kreitmann, Bernard, Léger, Pierre-Louis, Rambaud, Jerome
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.05.2022; BioMed Central; BMC
• Subjects: Autonomic Nervous System Diseases; Blood oxygenation, Extracorporeal; Child; Complications and side effects; Coronary vessels; Correspondence; Critical care; Diagnosis; Extracorporeal Membrane Oxygenation; Flushing; Human health and pathology; Humans; Hypohidrosis; Infant, Newborn; Lamellar ichthyosis; Life Sciences; Pediatric research; Pediatrics; Retrospective Studies; Veins & arteries; France
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-022-04017-w

[...]the reduction in the left ventricular preload by a large interatrial communication or the presence of LV dysfunction may be so important that the aortic valve remains closed, VA-ECMO then provides full circulatory support, no HS exists and the coronaries arteries are well oxygenated (Fig. 1C). [...]adding a re-injection cannula in the femoral vein to offer a hybrid veno-arterio-venous ECMO will help to ensure coronary oxygenation by potentially increasing transpulmonary blood flow and oxygen content of pulmonary blood at the cost of recirculation [5]. [...]HS must be suspected and prevented in all VA-ECMO patients in order to avoid a prolongated or a secondary/recurrent cardiac dysfunction.