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Case Reports
. 2023 Jan-Mar;26(1):97-101.
doi: 10.4103/aca.aca_176_21.

Management of harlequin syndrome under ECPELLA support: A report of two cases and a proposed approach

Matteo Giunta  1 , Elisa G Recchia  1 , Paolo Capuano  1 , Antonio Toscano  1 , Matteo Attisani  2 , Mauro Rinaldi  2 , Luca Brazzi  1
Affiliations
Case Reports

Management of harlequin syndrome under ECPELLA support: A report of two cases and a proposed approach

Matteo Giunta et al. Ann Card Anaesth. 2023 Jan-Mar.

Abstract

The use of ECPELLA in patients with severe lung disease may result in an unfavorable phenomenon of differential hypoxia. The simultaneous evaluation of three arterial blood samples from different arterial line (right radial artery, left radial artery, ECMO arterial line) in patients at risk of Harlequin syndrome (also called differential hypoxemia (DH)) can localize the "mixing cloud" along the aorta. Focusing the attention on the "mixing cloud" position instead of on isolated flows of Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) and Impella CP makes the decision making easier about how to modify MCSs flows according to the clinical context. Herein, we present two cases in which ECPELLA configuration was used to treat a cardiogenic shock condition and how the ECPELLA-induced hypoxia was managed.

Keywords: Cardiogenic shock; ECMO; ECPELLA; Harlequin syndrome; mechanical cardiovascular support.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
ECO-TEE: freezed image of the mixing cloud in the aortic arch
See this image and copyright information in PMC

References

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Supplementary concepts