26, 22, 40
Single case. Man in his sixties, arrest from contrast-related anaphylaxis, placed on VA ECMO. Echocardiography IMMEDIATELY AFTER CANNULATION SHOWED NO PERICARDIAL EFFUSION. Flow about 2 L/min, systolic pressure 80–100 mmHg, central venous pressure 9–11 mmHg, heparin to an activated clotting time of about 150 seconds.
Ten hours later blood pressure fell to 50 mmHg and CENTRAL VENOUS PRESSURE ROSE TO 35 mmHg. Repeat echocardiography showed a pericardial effusion. Drainage of 450 mL of bloody effusion restored CVP to 9–11 mmHg and pressure to 80–100 mmHg. The fluid had haemoglobin 11 g/dL and a partial pressure of oxygen of 24.8 mmHg, indicating venous blood. Right fourth to eighth rib fractures from compressions. Weaned on day 3, discharged at 83 days.
Authors' own explanation: the bleeding was probably trivial initially and was accelerated by anticoagulation, and the progression escaped notice at the early stage because circulation was maintained with ECMO, becoming apparent only with circulatory collapse.
Why it is in the database: it documents the exact time course and mechanism that ELSO Red Book Chapter 48 describes in the abstract, and it is the evidential basis for Chapter 26's rule that a rising central venous pressure on ECMO is a tamponade sign until imaged.
Read as indexed full-text passages. DOI not independently resolved.