Watershed of veno-arterial extracorporeal life support

A 39-year-old female received veno-arterial extracorporeal life support (ECLS) via femoral vessels for cardiogenic shock. Computed tomography demonstrated a watershed, resulting from contrast-enhanced retrograde perfusion via the ECLS and native antegrade cardiac output (Fig. 1 A and B). Cerebral oxygenation may be compromised if ECLS perfusion does not reach the origins of supra-aortic arteries. In this case, the increase of ECLS flow resulted in improved upper body oxygenation, and the patient was successfully weaned from ECLS and survived. ( A ) Oblique computed tomography reconstruction in an aortic arch plane. Retrograde contrast-enhanced extracorporeal life support (ECLS) flow meets native cardiac output in the distal aortic arch. ( B ) Three-dimensional reconstruction of the descending aorta, oblique dorsal view.