CTSCAN EQUIVALENT OF HARLEQUIN SYNDROME FOLLOWING ECMO IMPLANTATION MIMICKING AORTIC DISSECTION

Introduction: Extra-corporeal-membrane-oxygenation (ECMO) is a frequent rescue treatment for acute cardiac dysfunction and/or sudden cardiac arrest. CT scan is frequently scheduled following ECMO implant and, unfortunately, flow artifacts could be difficult to discern from severe pathologic conditions such as pulmonary embolism or acute aortic dissection (AAD). Here we reviewed our series of ECMO-patients undergoing acute CTscan in order to evaluate a potential dramatic mistake in CT scan interpretation in patients in ECMO. Materials and Methods: Out of 58 ECMO implanted at our Division, in the last 12-month, 6 patients received early CT-scan. We reviewed all ct scan and we analysed potential flow artifacts leading to misdiagnosis during CTscan report. CT scan report were compared to hemodynamical and clinical status. Results: Out of 6 patients receiving contrast-CTscan following ECMO implantation, in 2 patients signs of AAD were reported. In case 1 suspicious of AAD from aortic root was diagnosed following ECMO implantation in cath-lab. Following favourable clinical course and ECMO weaning, CTscan showed no-sign of AAD. In case 2 AAD was diagnosed following ECMO implantation due to sudden cardiac arrest but was not confirmed at TE- Echo. Patient died within 48hour without necroscopical assessment. Conclusion: Following ECMO implantation, cardiac recovery, can cause ejection of poorly oxygenated blood, leading to selective distal hypoxia. This phenomenon, was named Harlequin syndrome. CTscan equivalent of harlequin syndrome could be a dissection-like image which has to be recognized by experienced radiologist at time of early CT report to avoid potential drastic consequence.