A 52-year-old man on VA-ECMO for refractory cardiogenic shock develops differential hypoxia: SpO2 on his right hand (radial arterial line) is 98%, whi...

Question

A 52-year-old man on VA-ECMO for refractory cardiogenic shock develops differential hypoxia: SpO2 on his right hand (radial arterial line) is 98%, while SpO2 on his left foot is 75%. The ECMO return cannula is in the right femoral artery. What is the most likely explanation?

Accepted Answer

North-South syndrome (Harlequin syndrome) - recovering native cardiac output ejecting deoxygenated blood from poorly functioning lungs into the aortic root, competing with oxygenated ECMO blood returning retrograde from the femoral artery

Answer

ECMO circuit oxygenator failure

Answer

Femoral arterial cannula malposition

Answer

Left leg deep vein thrombosis

Answer

Aortic dissection caused by the ECMO cannula

uk-fficm MCQ (SBA): VA-ECMO Complication

A 52-year-old man on VA-ECMO for refractory cardiogenic shock develops differential hypoxia: SpO2 on his right hand (radial arterial line) is 98%, while SpO2 on his left foot is 75%. The ECMO return cannula is in the right femoral artery. What is the most likely explanation?