# Pericardial-Drain-to-Central-Venous-Line Return to Rescue Venoarterial Extracorporeal Membrane Oxygenation Flow in Tamponade From Stanford Type A Dissection: A Case Report

## TL;DR

A novel rescue technique using pericardial fluid reinfusion helped stabilize a patient with a severe aortic dissection during life-saving heart-lung support.

## Contribution

A high-risk, last-resort technique to reinfuse pericardial fluid into venous circulation to improve ECMO flow during tamponade from aortic dissection.

## Key findings

- Reinfusing pericardial effluent via a central venous line increased ECMO flow from 1.5-2.0 to 2.5-2.8 L/minute.
- The maneuver stabilized hemodynamics temporarily, allowing surgical repair in a patient with Stanford type A dissection.
- The patient ultimately died due to coagulopathy and bleeding post-surgery.

## Abstract

Cardiac tamponade secondary to Stanford type A aortic dissection carries extremely high mortality, and pericardiocentesis may precipitate catastrophic hemorrhage; during extracorporeal cardiopulmonary resuscitation (ECPR), elevated pericardial pressure can further impair venous return and limit venoarterial extracorporeal membrane oxygenation (VA-ECMO) flow. An 87-year-old woman suffered cardiac arrest due to tamponade from Stanford type A dissection and underwent ECPR, but venous drainage was severely compromised, and ECMO flow remained low (1.5-2.0 L/minute). Echocardiography showed progressive pericardial effusion, and pericardial drainage produced high-pressure bloody output consistent with ongoing rupture. As a rescue maneuver to maintain systemic perfusion, the pericardial drain was connected to a central venous line via an interposed syringe to reinfuse pericardial effluent into the venous circulation, improving ECMO flow to 2.5-2.8 L/minute and stabilizing hemodynamics long enough to proceed to surgical repair; computed tomography confirmed Stanford type A dissection. The patient underwent a bio-Bentall procedure but died of refractory coagulopathy and bleeding on postoperative day 2. Reinfusion of pericardial effluent into the central venous system may transiently restore venous return and stabilize ECMO flow in tamponade complicating Stanford type A dissection during ECPR and should be considered only as a high-risk, last-resort bridge under continuous hemodynamic and circuit monitoring until definitive surgical correction is achieved