Shifting Surgical Archetypes of ICG Fluorescent-Angiography for Bowel
Perfusion Assessment in Cardiogenic Shock Under ECMO Support
Abstract
Extracorporeal membrane oxygenation (ECMO) has been adopted to support
patients with acute severe cardiac or pulmonary failure that is
potentially reversible and unresponsive to conventional management. In
the presence of pulmonary embolism, mesenteric ischemia (MI) can present
as a life-threatening disorder that leads to intestinal ischemia. Due to
the nature and acuity of these conditions, determining adequate
perfusion upon surgical intervention is challenging for the operating
surgeon, especially in the presence of cardiogenic shock despite ECMO
support. Indocyanine green fluorescent angiography (ICG-FA) has proven
to be useful for real-time vascular perfusion assessment, which may
potentially decrease the rate of development of perfusion-related
complications. The case report here-in presented, breaks the paradigm of
performing noncardiac surgical procedures on ECMO support via a
pioneering visual aid technique. Learning objective Indocyanine green
fluorescent angiography (ICG-FA) is a promising visual trans-operatory
technique providing real-time feedback for the adequate identification
and assessment of target tissue/organs. The high morbidity and mortality
rates associated to MI and CS – particularly when concomitantly present
– hinders salvage surgical therapy. The use of acute ECMO provides
stabilization yet lacks any curative solutions. This case report
highlights the importance of adequate surgical intervention under
extracorporeal life support in the presence of both CS and MI. To the
authors’ knowledge, said approach has never been attempted, yet trails a
promising therapy for the improvement of associated mortality rates.