From: The ABCDE approach to difficult weaning from venoarterial extracorporeal membrane oxygenation
Examination | Signs | Possible diagnosis |
---|---|---|
Clinical signs | Loud systolic murmur | VSR, MR, or LVOT gradient |
 | Pulsus paradoxus | Cardiac tamponade |
Telemetry | Bradycardia, (supra)ventricular tachycardia | Arrhythmia/conduction disorder |
ECG | ST segment/T wave abnormalities | Myocardial ischemia |
 | Specific arrhythmia-related signs | Arrhythmia |
 | PQ interval and QRS width | Conduction disorder/dyssynchrony |
Laboratory values | Troponin, CK-MB | Myocardial ischemia |
 | ABG, ScVO2, SmVO2 | Pulmonary gas exchange, oxygen supply, and demand balance |
 | Hemoglobin levels | Oxygen supply |
 | Electrolytes | Electrolyte disturbances, adrenal insufficiency |
 | TSH, fT4, fT3 | Thyroid dysfunction |
 | CRP, PCT | Infection, inflammation |
Echocardiography | RV and LV function and VTI | Impaired contractility |
 | Regional wall motion abnormalities | Myocardial ischemia, dyssynchrony |
 | Valvular regurgitation and its severity | Severe MR or AR |
 | Dynamic pressure gradient LVOT and SAM | LVOT gradient |
 | Pericardial effusion/thrombus | Cardiac tamponade |
Pulmonary artery catheter | Elevated PA pressures/PVR | High RV afterload |
 | Elevated CVP | Cardiac tamponade |
 | Elevated CVP and PCWP | Fluid overload/decompensation |
 | Significant step-up in oxygen saturation (from RA to PA) | VSR |
X-ray/ CT scan | Atelectasis | RV afterload |
 | Pleural effusion Pneumonia | RV afterload |
 | Pulmonary embolism | RV afterload |