Q: What's the etiology behind cardiac thrombosis in extracorporeal membrane oxygenation (ECMO) inserted through femoral vessels?
Answer:
Most of the Veno-Arterial (VA) ECMO are inserted in ICU are through femoral artery and vein in emergent code situations. This creates a retrograde blood flow in the ascending aorta resulting in stasis of the blood in left ventricle. Unfortunately, most of these patients have a poor left ventricular function which exacerbates the risk of cardiac thrombosis. Proper anti-coagulation is a prerequisite to avoid this complication.
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Reference:
Makdisi G, Hashmi ZA, Wozniak TC, Wang IW. Left ventricular thrombus associated with arteriovenous extra corporeal membrane oxygenation. J Thorac Dis. 2015;7(11):E552–E554. doi:10.3978/j.issn.2072-1439.2015.11.18
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