Skip to main content
Fig. 1 | Critical Care

Fig. 1

From: Hidden Harlequin syndrome in neonatal and pediatric VA-ECMO

Fig. 1

The Harlequin Syndrome during VA-ECMO in neonates and children with severe acute respiratory distress syndrome. In severe (A) to moderate (B) LV dysfunction, the “mixing” point is in the middle of ascending aorta. In these two situations, the Harlequin syndrome is invisible: the four limbs are fully oxygenated but the coronary arteries are not. C In profound left ventricle (LV) dysfunction there is no LV ejection and no mixing. The Harlequin syndrome is not present, coronary arteries are well oxygenated. D. In the subnormal LV recovery, the “mixing” point is close to the beginning of the brachio-cephalic trunk. The blood flows coming from VA-ECMO and LV are mixed: the saturation is decreased in the descending aorta and allows to detect easier Harlequin syndrome. Asterisk: The mixing point according to LV function. E. Screenshot of two peripheral oxygen saturations (right hand and lower limb) associated with invasive arterial pressure during 2 h. The represented curves are not the real-time data but the trends. Before LV recovery (a) the arterial pulse pressure is decreased (i.e., the stroke volume of LV is decreased (white asterisk) and the peripheral oxygen saturation of lower limb is increased (white arrow) at the same level of the saturation of right upper limb (white dotted arrow). After LF recovery (b), the arterial pulse pressure is increased (pink asterisk) with a lowered oxygen saturation in the lower limb (pink arrow), whereas the oxygen saturation remained normal in the right upper limb (pink dotted arrow)

Back to article page