Related Experiment Video
Updated: Nov 6, 2025
06:22
Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
Published on: April 7, 2021
3.6K
[Refractory pulmonary edema under ECMO: Is there a place for Rashkind atrioseptotomy?]
V Pham1, M Schmidt1, T Chastre2
1Service de réanimation médicale, institut de cardiologie, groupe hospitalier Pitié-Salpêtrière, 75651 Paris cedex 13, France.
Annales De Cardiologie Et D'Angeiologie
|May 7, 2021
Summary
Hydrostatic pulmonary edema is a serious complication of extracorporeal membrane oxygenation (ECMO). The Rashkind technique can be a viable option for left ventricle unloading and improving hypoxemia in select patients.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Intensive Care Medicine
Background:
- Hydrostatic pulmonary edema is a known complication of venoarterial extracorporeal membrane oxygenation (VA-ECMO).
- It arises from increased left ventricle afterload due to retrograde aortic blood flow.
- Current left ventricle venting strategies include intra-aortic balloon pump, Impella, surgical cannulation, and Rashkind atrial septostomy.
Purpose of the Study:
- To report two cases of hydrostatic pulmonary edema in patients undergoing VA-ECMO.
- To evaluate the feasibility and efficacy of the Rashkind technique for managing this complication.
- To highlight the importance of pre-procedural assessment for potential contraindications.
Main Methods:
- Case report of two patients experiencing hydrostatic pulmonary edema during VA-ECMO.
- Application of the Rashkind technique in the first case for left ventricle unloading.
- Transesophageal echocardiography in the second case to identify a left atrial thrombus preventing the Rashkind procedure.
Main Results:
- The Rashkind technique was successfully performed in the first patient, leading to improved hypoxemia and effective left ventricle unloading.
- In the second patient, transesophageal echocardiography revealed a large left atrial thrombus extending to the pulmonary veins, precluding the Rashkind maneuver and contributing to elevated hydrostatic pressure.
- These cases underscore the clinical significance and potential severity of VA-ECMO-induced pulmonary edema.
Conclusions:
- The Rashkind technique is a feasible option for managing hydrostatic pulmonary edema during VA-ECMO, offering significant left ventricle unloading and hypoxemia improvement.
- Pre-procedural transesophageal echocardiography is crucial to rule out left atrial thrombi that can impede the Rashkind procedure and exacerbate pulmonary edema.
- Early identification and management of pulmonary edema are vital for patients on VA-ECMO.
Keywords:
Atrioseptotomie de RashkindCardiogenic shockChoc cardiogéniqueECMOPulmonary edemaRashkind atrioseptotomyŒdème aigu pulmonaireMore Related Videos
09:54Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
2.0K
07:41Insertion, Maintenance, and Removal of the Percutaneous Dual Lumen Cannula Right Ventricular Assist Device
Published on: July 20, 2022
2.1K
Related Concept Videos
01:29Acute Respiratory Failure-V
264
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
264
01:30Acute Respiratory Failure-III
440
Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without...
440
01:27Pneumothorax-II
557
Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
Clinical Manifestations:
Clinical Manifestations:
557
01:23Acute Respiratory Failure-IV
316
Respiratory failure can manifest suddenly or gradually, characterized by a rapid decline in PaO2 and a rapid rise in PaCO2. This situation indicates a severe respiratory problem that may quickly become a life-threatening emergency. One of the early signs of hypoxemic Acute Respiratory Failure (ARF) is a change in mental status due to the brain's sensitivity to oxygen levels and changes in acid-base balance. Symptoms such as restlessness, confusion, and agitation suggest inadequate oxygen...
316
01:29Cardiomyopathy IV: Restrictive Cardiomyopathy
158
Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
158
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
253
Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
253