Total reversal of the pulmonary circulation (RPC) induced by peripheral cannulation for veno-arterial ECMO in a patient with aortic and mitral valve insufficiency: a case report

This case report details a rare instance of total reversal of the pulmonary circulation (RPC) in a 56-year-old male patient on veno-arterial extracorporeal membrane oxygenation (V-A ECMO) during emergency cardiopulmonary resuscitation (eCPR) following a myocardial infarction and cardiac arrest. Previously unrecognized aortic and mitral valve regurgitations, along with V-A ECMO flow, resulted in severe pulmonary edema. We describe how pulmonary artery cannulation and modifying the ECMO circuit to veno-pulmonary arterial-arterial (VPa-A) ECMO successfully alleviated the severe pulmonary edema but may have caused reversal of the pulmonary circulation (RPC). To our knowledge, this is the first reported case of this phenomenon in a human.