CTICasesVAV ECMO for Differential Hypoxia
Imaging findings
Chest radiograph and CT post-CABG show two separate cannulae positioned in the inferior vena cava and one in the femoral artery. The patient was switched from VA ECMO to veno-arterio-venous (VAV) ECMO.
Key takeaways
Differential hypoxia (Harlequin syndrome) is a complication of femoral VA ECMO where the heart recovers but the lungs remain injured, leading to perfusion of the upper body with deoxygenated blood. Upgrading to VAV ECMO (by adding a venous return cannula to the IVC/SVC) delivers oxygenated blood to the lungs and resolves upper body hypoxia.
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