Pink Toes and Blue Brain on VA ECMO (North South Syndrome on ECMO)
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Pink Toes and Blue Brain on VA ECMO (North South Syndrome on ECMO)
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In this episode of *PICU Doc on Call*, Dr. Monica Gray and Dr. Pradip Kamat are joined by fellow Dr. Hope Vancleve to discuss a complex case of a 12-year-old with MRSA septic shock requiring VA ECMO. The conversation covers sepsis-induced myocardial dysfunction, including its pathophysiology, diagnosis, and management. The hosts also explore differential hypoxia, or Harlequin syndrome, a serious VA ECMO complication causing upper body deoxygenation, and discuss monitoring strategies and circuit reconfiguration to prevent cerebral and myocardial ischemia.
Show Highlights:
- Clinical case discussion of a 12-year-old male patient with MRSA septic shock.
- Complications of sepsis, including sepsis-induced myocardial dysfunction and refractory shock.
- Management strategies for septic shock, including antibiotic therapy and fluid resuscitation.
- Use of venoarterial ECMO support in pediatric patients with severe cardiac dysfunction.
- Pathophysiology of sepsis-induced myocardial dysfunction and its impact on cardiac function.
- Differential hypoxia (North-South syndrome) in patients on femoral VA ECMO.
- Diagnostic approaches for sepsis-induced myocardial dysfunction, including echocardiography and biomarkers.
- Importance of monitoring and managing end-organ function in septic patients.
- Strategies for addressing differential hypoxia in ECMO patients, including circuit reconfiguration.
- Discussion of the risks and benefits of various ECMO configurations and management techniques.
References:
- Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter
- Reference 1: Torre DE, Pirri C. Harlequin Syndrome in Venoarterial ECMO and ECPELLA: When ECMO and Native or Impella Circulations Collide - A Comprehensive Review. Rev Cardiovasc Med. 2025 Aug 26;26(8):39992. doi: 10.31083/RCM39992. PMID: 40927093; PMCID: PMC12415751.
- Reference 2 : Cove ME. Disrupting differential hypoxia in peripheral veno-arterial extracorporeal membrane oxygenation. Crit Care. 2015 Jul 22;19(1):280. doi: 10.1186/s13054-015-0997-3. PMID: 27391473; PMCID: PMC4511033.
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