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Harlequin effect and central veno-arterial extracorporeal life support

Published online by Cambridge University Press:  05 January 2023

Sudesh Prabhu Open the ORCID record for Sudesh Prabhu [Opens in a new window] ,
Balasubramanian Shanmugasundaram ,
Riyan Shetty ,
Sruti Rao Open the ORCID record for Sruti Rao [Opens in a new window]  and
Tom R. Karl Open the ORCID record for Tom R. Karl [Opens in a new window]
Sudesh Prabhu*
Affiliation:
Pediatric Cardiac Services, Narayana Institute of Cardiac Sciences, Bengaluru, India
Balasubramanian Shanmugasundaram
Affiliation:
Pediatric Cardiac Services, Narayana Institute of Cardiac Sciences, Bengaluru, India
Riyan Shetty
Affiliation:
Pediatric Cardiac Services, Narayana Institute of Cardiac Sciences, Bengaluru, India
Sruti Rao
Affiliation:
Pediatric Cardiac Services, Narayana Institute of Cardiac Sciences, Bengaluru, India
Tom R. Karl
Affiliation:
Queensland Pediatric Cardiac Research, University of Queensland, Brisbane, Australia
*
Author for correspondence: Sudesh Prabhu, Department of Pediatric Cardiac Surgery, Narayana Institute of Cardiac Sciences, 258/A Hosur Road, Bommasandra Industrial Area, Anekal Taluk, Bengaluru 560099, Karnataka, India. Tel: +919886899450. E-mail: sudesh006@gmail.com
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Abstract

“Harlequin effect” may be observed in the watershed region of a patient with pulmonary dysfunction, receiving peripheral veno-arterial extracorporeal membrane oxygenation via the femoral vessels. In such cases, retrograde oxygenated blood from the peripheral inflow cannula converges with the antegrade deoxygenated blood ejected from the left ventricle. This occurs when the left ventricle is ejecting significantly but the recovery of pulmonary function lags behind. Herein, we describe the occurrence of “Harlequin effect” in the setting of central veno-arterial extracorporeal membrane oxygenation that ensues due to the persistence of right ventricular dysfunction in the presence of an interatrial communication. This results in right to left shunting at the atrial level while weaning the patient from extracorporeal life support.

Keywords

Harlequin effectveno-arterial extracorporeal membrane oxygenationextracorporeal life supportright ventricular dysfunctionInteratrial communication
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 11 , November 2023 , pp. 2181 - 2184
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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