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Symmetrical peripheral gangrene in four pediatric cardiac surgery patients receiving extracorporeal membrane oxygenation.
MedLine Citation:
PMID:  22400489     Owner:  NLM     Status:  Publisher    
Abstract Background: Symmetrical peripheral gangrene (multi-limb ischemia without large artery occlusion) is a rare condition usually associated with disseminated intravascular coagulation (DIC), hemodynamic compromise and/or sepsis. However, it has not been described in patients on extracorporal membrane oxygenation (ECMO). Methods: Four pediatric patients developed symmetrical peripheral gangrene on ECMO following cardiac surgery, and subsequently expired and came to autopsy, over five years. History, physical examination and laboratory studies were examined. Gross and microscopic autopsy material was reviewed. Results: Patients were 11 days to 13 years old. ECMO duration was 11-22 days, and limb ischemia began 2-4 days prior to death. Three patients had rapid onset, with ischemia developing in <48 hours. In the fourth, ischemic changes began as focal lesions and gradually spread. Two patients were septic. Three had evidence of other end-organ damage. Pressors were used in three patients before the limb ischemia. Autopsies disclosed ischemic changes involving all limbs, with confluent ecchymoses. In a detailed examination in one case, large arteries of the extremities were patent. Involved skin and soft tissue showed bland fibrin thrombi in the microcirculation, with tissue necrosis and hemorrhage. Conclusions: We describe the first four cases of symmetrical peripheral gangrene complicating ECMO. The four pediatric patients all had recent surgery for congenital cardiac disease, and all had significant exposure to ECMO prior to developing limb ischemia. Symmetrical peripheral gangrene is an unusual complication of ECMO that may arise in the setting of DIC, sepsis or other hemostatic and/or hemodynamic imbalance.
Robyn C Reed
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-8
Journal Detail:
Title:  Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society     Volume:  -     ISSN:  1093-5266     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9809673     Medline TA:  Pediatr Dev Pathol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
University of Minnesota, Department of Laboratory Medicine and Pathology.
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