--- a
+++ b/processing/MACCROBAT/22515939.txt
@@ -0,0 +1,22 @@
+A 53 year old female without significant past medical history developed severe viral pneumonia, with rapid, progressive deterioration in her respiratory status.
+She developed ARDS and mechanical ventilatory management using ARDS protocol were unable to maintain adequate oxygenation.
+As a result, bedside VV-ECMO was planned.
+Transesophageal echocardiography (TEE) was performed to visualize proper positioning of the guidewire and cannula.
+Using the Seldinger technique, the right internal jugular vein was accessed and a guide wire was placed.
+Placement of the guidewire into the IVC proved difficult due to repeated migration of the guidewire into the right ventricle.
+After multiple attempts, the guidewire was visualized to course properly from the SVC to the IVC.
+After a bolus dose of 5000 units of intravenous heparin was given, the right internal jugular venous access site was dilated.
+Just as the final dilatation was completed and upon dilator exchange with simultaneous advancement of the 23 French Avalon cannula, TEE lost visualization of the guidewire.
+Multiple premature ventricular beats were noted and immediately, a new, rapidly enlarging pericardial effusion was detected (Figure ​(Figure2).2).
+Emergent preparations were made for bedside surgical decompression of the pericardial space.
+Quickly the patient lost blood pressure from acute cardiac tamponade.
+The Avalon cannula was immediately clamped at the end but not removed.
+A emergent subxiphoid pericardial window was performed, resulting in drainage of venous blood and restoration of blood pressure.
+Transfusion was initiated and the patient was emergently transported to the operating room for surgical exploration.
+The Avalon cannula was found to have perforated the apex of the right ventricle.
+The injury was repaired primarily and the Avalon cannula was repositioned toward the IVC again by TEE with additional direct manipulation.
+VV-ECMO was initiated and the oxygenation improved.
+Due to excessive coagulopathies, the sternum was left open but was closed on postoperative day 2.
+From that point, she remained free from any cardiac or infectious complications and her pulmonary condition slowly improved.
+She was successfully weaned from VV-ECMO on postoperative day 9 and was discharged home on postoperative day 24 without the need for home oxygen.
+She regained full physical functions at home and recovered normal pulmonary function by 3 months following discharge from the hospital.