22515939 Visualization

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