Images in Intensive Medicine
Lung ultrasound in hypoxic patient with veno-arterial ECMO
Ecografía pulmonar en el paciente con ECMO venoarterial hipóxico
L. Martin-Villen
, E. Jimenez-Martinez, R. Martin-Bermudez
Corresponding author
UGC Medicina Intensiva, Hospital Universitario Virgen del Rocío, Seville, Spain
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"apellidos" => "Martin-Villen" "email" => array:1 [ 0 => "luis.martin.exts@juntadeandalucia.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Jimenez-Martinez" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Martin-Bermudez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "UGC Medicina Intensiva, Hospital Universitario Virgen del Rocío, Seville, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ecografía pulmonar en el paciente con ECMO venoarterial hipóxico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 513 "Ancho" => 1400 "Tamanyo" => 70077 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 56-year-old patient admitted due to cardiogenic shock following an acute myocardial infarction. Peripheral veno-arterial extracorporeal oxygenation membrane (VA ECMO) was implanted as a bridge to decision. Five days later, patient developed differential hypoxemia between upper (SO2 77%) and lower body (SO2 100%). An echocardiogram showed left ventricular ejection fraction improvement from 10% to 30% and pulmonary ultrasound revealed a mild pleural effusion and a bilateral image of pulmonary consolidation with dynamic air bronchogram. Inside the bronchus, vermiform mobile hyperechoic images (black arrows, <a class="elsevierStyleCrossRef" href="#fig0005">figure 1</a>A) appeared synchronized with breathing (video 1). Simultaneous bronchoscopy showed purulent secretions (white arrow, <a class="elsevierStyleCrossRef" href="#fig0005">figure 1</a>B) going in and out of the bronchial tree (video 2). In patients with VA ECMO, beyond the echocardiogram, pulmonary ultrasound is essential to see lung patterns that could explain hypoxic and even to guide therapeutic attitudes.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of Interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0025" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0020" ] ] ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 513 "Ancho" => 1400 "Tamanyo" => 70077 ] ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 2804143 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 2 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 4942643 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004300000002/v1_201903070822/S2173572718302212/v1_201903070822/en/main.assets" "Apartado" => array:4 [ "identificador" => "64602" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Intensive Medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004300000002/v1_201903070822/S2173572718302212/v1_201903070822/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718302212?idApp=WMIE" ]
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