Femoral Arterial Cannulation

Abstract

Instituting cardiopulmonary bypass can be lifesaving for patients undergoing noncardiac surgery. We see this more frequently with patients undergoing general thoracic procedures or hepatic transplantation although it may be necessary in the setting of major vascular surgery as well. In this case a pulmonary artery injury is difficult to control and bypass was instituted similarly. Despite what seemed uneventful cannulation, the perfusionist is unable to perfuse adequately. While the aorta felt tense, radial artery pressure is low. This combination of findings suggests retrograde dissection with a pressurized false lumen compressing the radial artery line and accounting for the measured hypotension. Resistance to flow is due to the retrograde malperfusion. Although a number of clues were available and seem obvious in retrospect, in the moment you are misled. In the face of conflicting information one is well advised to slow down once thinking and shift into algorithmic problem-solving.