Cardiothorac Vasc Anesth Research Articles

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

Con: Limitations of POCUS Examination: Be Aware of Overdiagnosis and Undertreatment

ULTRASOUND IS A REVOLUTIONARY, noninvasive imaging tool that, when used and interpreted by trained personnel in the proper clinical situation, can provide correct diagnosis and treatment. Point-of-care ultrasound (POCUS) is defined as a handheld, mobile, broadly applied ultrasound machine capable of performing limited studies at bedside to provide answers to focused, closed-ended, binary questions. 1 Baribeau Y Sharkey A Chaudhary O et al. Handheld point-of-care ultrasound probes: The New generation of POCUS. J Cardiothorac Vasc Anesth. 2020; 34: 3139-3145 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar , 2 Reisinger NC Koratala A. Incorporating training in POCUS in nephrology fellowship curriculum. Clin J Am Soc Nephrol. 2022; 17: 1442-1445 Crossref PubMed Scopus (0) Google Scholar Over the last 15 years, the medical literature has demonstrated the importance of this tool in medical practice, 3 Miller DL Abo A Abramowicz JS et al. Diagnostic ultrasound safety review for point-of-care ultrasound practitioners. J Ultrasound Med. 2020; 39: 1069-1084 Crossref PubMed Scopus (17) Google Scholar with applications including delineation of airway structures, lung pathology, cardiac structure and function, gastric volume and content, guided vascular procedures, and emergent focused assessment with sonography for trauma examination. 4 Kalagara H Coker B Gersterin NS et al. Point-of-care ultrasound (POCUS) for the cardiothoracic anesthesiologist. J Cardiothorac Vasc Anesth. 2022; 36: 1132-1147 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar However, this readily accessible tool cannot completely replace patient history, physical examination, clinical judgment, and other formal imaging modalities read by a specialist for the diagnosis, monitoring, and treatment of patient clinical status. There is a concern for overdiagnosis and undertreatment of various clinical pathologies using POCUS, and future direction is needed to optimize this diagnostic tool and prevent overdiagnosis and undertreatment.

“TEG” talks: technology worth spreading?

“TEG” talks: technology worth spreading?

Caution Regarding Enclosures for Airway Procedures

Article| January 2023 Caution Regarding Enclosures for Airway Procedures Uday Jain, BSEE, MD, PhD, FASA Uday Jain, BSEE, MD, PhD, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor January 2023, Vol. 87, 29. https://doi.org/10.1097/01.ASM.0000911788.66274.ff Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Uday Jain; Caution Regarding Enclosures for Airway Procedures. ASA Monitor 2023; 87:29 doi: https://doi.org/10.1097/01.ASM.0000911788.66274.ff Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: airway procedure, airway device Several enclosures for placement around the head and upper torso have been described during this pandemic (Anesth Analg 2020;131:e135-36; J Cardiothorac Vasc Anesth 2021;35:966-67). They are usually made of frames covered by transparent sheets. The enclosures have access ports for the operator's arms, supplemental oxygen, and airway equipment. The enclosures do not form an airtight seal around the patient's head and torso. They provide partial source control by suctioning aerosol and infectious droplets. If suction devices currently available in hospitals are utilized, the enclosure may only slightly reduce interior pressures relative to the ambient pressure. Hopefully most infectious material remains inside the enclosure, but during doffing and disposal contaminated material may escape. Although an enclosure may reduce health care personnel (HCP) exposure, full personal protective equipment (PPE) is still required. No studies demonstrate safety, efficacy, or usability. What is unambiguous is that airway enclosures adversely affect visibility... You do not currently have access to this content.

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

RELATIONSHIP OF MORTALITY AND MORBIDITY WITH POSTOPERATIVE TROPONIN-I LEVELS IN CHILDREN UNDERGOING CARDIAC SURGERY

<h3>Introduction</h3> Intraoperative Intraoperative myocardial damage is a mean determinant of postoperative cardiac dysfunction associated with mortality and morbidity in cardiac surgery (1). Cardiac troponin I (TnI) is a particular predictive marker of myocardial injury in the young population, and its increased levels predict mortality after cardiac surgery (2).The purpose of our study was to evaluate the effect of troponin I on postoperative mortality and morbidity in children undergoing cardiac surgery. <h3>Methods</h3> We prospectively measured Tn I levels (preoperative, at the pediatric intensive care unit arrival, at 24 and 48 hours) in 125 children undergoing cardiac surgery.115 were survivors and 10 were nonsurvivors. Aortic cross clamp time (ACC time), cardiopulmonary bypass time (CPB time), inotropic score, duration ventilation, PICU stay were recorded. <h3>Results</h3> Tn I levels were significantly higher in nonsurvivors at 24 and 48 hours (respectively, p=0,04, p=0,02). ACC,CPB times and inotropic score were higher in nonsurvivors than survivors. <h3>Conclusions</h3> Higher TnI levels are associated with increased morbidity in children undergoing cardiac surgery. <h3>References</h3> <ul><li>1. Eigel P, van Ingen G, Wagenpfeil S. Predictive value of perioperative cardiac troponin I for adverse outcome in coronary artery bypass surgery. Eur J Card Surg 2001;20:544-9.</li><li>2. Momeni M, Poncelet A, Rubay J, et al. Does postoperative cardiac troponin I have any prognostic value in predicting midterm mortality after congenital cardiac surgery. Cardiothorac Vasc Anesth. 2017;31:122-7.</li></ul>

REFRACTORY HYPOXEMIA: A CASE OF DAPSONE-INDUCED METHEMOGLOBINEMIA IN A PATIENT WITH COVID-19

REFRACTORY HYPOXEMIA: A CASE OF DAPSONE-INDUCED METHEMOGLOBINEMIA IN A PATIENT WITH COVID-19

Con: Lumbar Drains Should Routinely Be Placed by a Landmark Approach and Not by Fluoroscopic Guidance for Elective Thoracic Aortic Repairs

SPINAL CORD ISCHEMIA (SCI) after thoracoabdominal aortic repair is a well-known complication of both open and endovascular surgery, with reported rates as high as 5%-to-21% after open repair. 1 Gravereaux EC Faries PL Burks JA et al. Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysm. Jour of Vasc Surg. 2001; 34: 997-1003 Abstract Full Text Full Text PDF PubMed Scopus (260) Google Scholar Resultant morbidity, including paraparesis and paraplegia, are devastating, and a fair amount of research has gone into developing strategies for mitigating SCI-related complications. Cerebrospinal fluid drainage (CSFD) with the placement of lumbar drains (LDs) is considered the current recommendation for both prevention and treatment of SCI in high-risk patients. 2 Coselli JS LeMaire SA Koksoy C et al. Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial. J Vasc Surg. 2002; 35: 631-639 Abstract Full Text Full Text PDF PubMed Scopus (520) Google Scholar ,3 Hiratzka LF Bakris GL Beckman JA et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010; 121: e266-e369 Crossref PubMed Scopus (1914) Google Scholar While there is some controversy over the utility of CSFD for endovascular repairs, it is still a widely accepted practice that is performed frequently for patients at high risk of developing SCI postrepair. 4 Isaak RS Furman W. Con: Patients at risk for spinal cord ischemia after thoracic endovascular aortic repairs should not receive prophylactic cerebrospinal fluid drainage. J Cardiothorac Vasc Anesth. 2015; 29: 1381-1383 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Protocols regarding the placement of LDs can vary by institution, whereby some centers may routinely use imaging guidance for the procedure. In this review, the authors examine the specifics of using fluoroscopic guidance for the preoperative placement of LDs in patients who are at a high risk of developing SCI after thoracoabdominal aortic repair. It is the authors’ belief that the universal use of fluoroscopic guidance is unnecessary, potentially harmful, confers additional expense, and is unsupported by the current body of evidence.

Pro: Fluoroscopic Guidance Should Be Routinely Used to Place Cerebrospinal Fluid Drains for Patients Undergoing Aortic Surgery

PER THE SOCIETY for Vascular Surgery clinical guidelines, use of cerebrospinal fluid drains (CSFDs) should be considered for appropriately-selected patients undergoing extensive aortic repair. 1 Upchurch GR Escobar GA Azizzadeh A et al. Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg. 2021; 73: 55S-83S Abstract Full Text Full Text PDF PubMed Scopus (90) Google Scholar Use of CSFDs enhances spinal cord perfusion pressure, thus ameliorating the detrimental effects in vulnerable watershed regions caused by the surgical reduction in blood supply, and thereby preventing devastating spinal cord ischemia (SCI). It is important to note that patients who experience SCI after aortic repairs have significantly worse long-term survival than those without this complication. More importantly, patients who have a return of neurologic function after SCI can anticipate similar life expectancy compared to those without SCI. There is plenty of evidence suggesting that prophylactic use of CSFDs in selected high-risk patients undergoing aortic repairs reduces the incidence of postoperative SCI. 2 DeSart K Scali ST Feezor RJ et al. Fate of patients with spinal cord ischemia complicating thoracic endovascular aortic repair. J Vasc Surg. 2013; 58 (e2): 635-642 Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar A recent meta-analysis that included 3,561 patients from 34 studies, demonstrated a lower incidence of SCI when CSFDs were placed routinely, as opposed to use only in patients meeting specified criteria. 3 Zhang Z Zhou Y Lin S et al. Systematic review and meta-analysis of association of prophylactic cerebrospinal fluid drainage in preventing spinal cord ischemia after thoracic endovascular aortic repair. J Vasc Surg. 2022; 75 (e5): 1478-1489 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Hence, the use of CSFDs will be warranted in selected patients undergoing aortic repairs who are at a high risk of SCI. 4 Arora H Ullery BW Kumar PA et al. Pro: Patients at risk for spinal cord ischemia after thoracic endovascular aortic repairs should receive prophylactic cerebrospinal fluid drainage. J Cardiothorac Vasc Anesth. 2015; 29: 1376-1380 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Although CSFDs are an essential tool in the prevention of SCI caused by the surgery, CSFD placement is not without risk. Rong et al. published a meta-analysis that included 4,714 patients across 34 studies who underwent open and endovascular aortic repairs with CSFDs. 5 Rong LQ Kamel MK Rahouma M et al. Cerebrospinal-fluid drain-related complications in patients undergoing open and endovascular repairs of thoracic and thoraco-abdominal aortic pathologies: a systematic review and meta-analysis. Br J Anaesth. 2018; 120: 904-913 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar This analysis focused on CSFD-related complications, with a 6.5% rate of pooled events, 2.5% of which represented severe complications, including epidural hematoma, intracranial hemorrhage, subarachnoid hemorrhage, meningitis, and/or catheter-related neurologic deficit. Risk factors for increased technical difficulty or even failed CSFD placement included atypical anatomy, such as from prior lumbar spine surgery, osteoarthritis or scoliosis, and poor surface landmarks, as can occur with a higher body mass index. 6 Awad H Ramadan ME Tili E et al. Fluoroscopic-guided lumbar spinal drain insertion for thoracic aortic aneurysm surgery. Anesth Analg. 2017; 125: 1219-1222 Crossref PubMed Scopus (4) Google Scholar

Practical Approaches to Reducing Cross-Contamination

Features| August 2022 Practical Approaches to Reducing Cross-Contamination Barry Swerdlow, MD, FASA; Barry Swerdlow, MD, FASA Search for other works by this author on: This Site PubMed Google Scholar Harriet W. Hopf, MD, FUHM, FASA Harriet W. Hopf, MD, FUHM, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor August 2022, Vol. 86, 23. https://doi.org/10.1097/01.ASM.0000855668.67412.6a Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Barry Swerdlow, Harriet W. Hopf; Practical Approaches to Reducing Cross-Contamination. ASA Monitor 2022; 86:23 doi: https://doi.org/10.1097/01.ASM.0000855668.67412.6a Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: anesthesia machine, gloves, protective, pathogenic organism, perioperative care, washing hands, infectious disease prevention / control, professors, therapeutics, infections, laryngoscopes Anesthesiologists and patients are at risk for cross-contamination and cross-infection during routine clinical care (Clinical Anesthesia. 2017; Anesth Analg 2020;131:37-42; Curr Anesthesiol Rep 2020;10:233-41; J Anesth 2020;34:575-84). The SARS-CoV-2 pandemic emphasized the risk of such perioperative transmission (Anesth Analg 2020;131:37-42; Cardiothorac Vasc Anesth 2021;35:1503-8). In this article, we review practical considerations related to these hazards. Hand hygiene, including hand washing, use of hand sanitizer, and appropriate use of gloves, reduces transmission of pathogens to patients and protects anesthesia providers from spread of disease via fomites, secretions, and blood (Clinical Anesthesia. 2017; Anesth Analg 2020;131:37-42; Curr Anesthesiol Rep 2020;10:233-41). Alcohol-based hand sanitizer, either body-worn or placed in proximity to the anesthesia machine, enhances compliance with hand hygiene protocols and reduces postoperative infection rates (Clinical Anesthesia. 2017; Anesth Analg 2020;131:37-42; Curr Anesthesiol Rep 2020;10:233-41). Gloves are... You do not currently have access to this content.

Anesthetic Management in Parturients With Fontan Physiology

Anesthetic Management in Parturients With Fontan Physiology

Anticoagulation as secondary prevention of massive lung thromboses in hospitalized patients with COVID-19

Anticoagulation as secondary prevention of massive lung thromboses in hospitalized patients with COVID-19

Atrial Embolization after a Transcatheter Mitral Valve Replacement

Atrial Embolization after a Transcatheter Mitral Valve Replacement

DUPLICATE: Combined Stroke and Spinal Cord Infarction in Hybrid Type I Aortic Arch Debranching and TEVAR and the Dual Role of the Left Subclavian Artery

AORTIC ARCH pathology, as a part of acute aortic syndrome, is a difficult clinical problem to address. Whether it presents as an intramural hematoma with impending rupture, isolated aneurysmal disease, or acute localized dissection, it creates a clinical challenge to the perioperative team. Some of the difficulty stems from determining the best operative strategy, either an open approach, total endovascular repair, or a hybrid of the two. Hybrid aortic arch repair involves 2 steps—open aortic branch revascularization and endovascular aortic repair. 1 Gregory AJ Prusinkiewicz CA Herget E et al. Subclavian graft thrombosis as an alternative cause for delayed spinal cord ischemia following hybrid aortic arch repair. J Cardiothorac Vasc Anesth. 2014; 28: 718-722 Google Scholar Variations of these 2 steps may be used. Each involves its own set of risks.

Combination of a vascular plug and coiling to treat an ascending aortic pseudoaneurysm following aortic surgery

Combination of a vascular plug and coiling to treat an ascending aortic pseudoaneurysm following aortic surgery

Repair of Kommerell's Diverticulum and Aberrant Subclavian Arteries: Classification of the Five Groups in Declining Frequency and Their Operative Approaches

Repair of Kommerell's Diverticulum and Aberrant Subclavian Arteries: Classification of the Five Groups in Declining Frequency and Their Operative Approaches

Con: Extubating in the Operating Room After Cardiac Surgery Is Not Necessary

CARDIAC SURGERY PATIENTS are among the highest risk patients for postoperative pulmonary complications, acute kidney injury, and increased length of hospital stay. 1 Pahwa S Bernabei A Schaff H et al. Impact of postoperative complications after cardiac surgery on long-term survival. J Card Surg. 2021; 36: 2045-2052 Crossref PubMed Scopus (3) Google Scholar In an attempt to decrease these risks, enhanced recovery or fast-track pathways after cardiac surgery have gained traction in recent years. Early extubation is one area of such a pathway that has been shown to decrease the length of stay and reduce healthcare costs in this population. 2 Higgins TL. Pro: Early endotracheal extubation is preferable to late extubation in patients following coronary artery surgery. J Cardiothorac Vasc Anesth. 1992; 6: 488-493 Abstract Full Text PDF PubMed Scopus (113) Google Scholar While most will agree that extubation within 6 hours is ideal after uncomplicated cardiac surgery, there has been an increasing push to take it one step further and provide routine on-table extubation (OTE) after cardiac surgery. To date, there are no randomized controlled trials to support that OTE provides any further benefit over standard fast-track extubation and, thus, should not be routinely performed.

Con: Interviews for Adult Cardiothoracic Anesthesiology Fellowship Program: In Favor of the In-Person Interview

SINCE ITS accreditation in 2006, the Adult Cardiothoracic Anesthesiology fellowship has become extremely competitive, as revealed by the increased number of applicants. 1 Capdeville M Hargrave J Patel PA et al. Contemporary challenges for fellowship training in adult cardiothoracic anesthesiology: Perspectives from program directors around the United States. J Cardiothorac Vasc Anesth. 2020; 34: 2047-2059 Google Scholar Candidates submit applications online through the SF (San Francisco) Match to programs of interest. 2 Feinman JW Roberts ML Al-Ghofaily L et al. the fellowship experience in adult cardiothoracic anesthesiology—strategies for applicants and fellows to navigate the coronavirus crisis. J Cardiothorac Vasc Anesth. 2020; 34: 2561-2565 Google Scholar Fellowship programs invest substantial time, labor, and resources to select a subset of applicants for interview, 3 Haas MRC He S Sternberg K et al. Reimagining residency selection: Part 1-a practical guide to recruitment in the post-COVID-19 era. J Grad Med Educ. 2020; 12: 539-544 Google Scholar ,4 Sternberg K Jordan J Haas MRC et al. Reimagining residency selection: Part 2—a practical guide to interviewing in the post-COVID-19 era. J Grad Med Educ. 2020; 12: 545-549 Google Scholar which plays a paramount role in the final selection process. 5 Huppert LA Hsiao EC Cho KC et al. Virtual interviews at graduate medical education training programs: Determining evidence-based best practices. Acad Med. 2021; 96: 1137-1145 Google Scholar It also provides a platform for sharing information between candidates and fellowship programs, showcasing their own strengths while evaluating each other. 6 Joshi A Bloom DA Spencer A et al. Video interviewing: A review and recommendations for implementation in the era of COVID-19 and beyond. Acad Radiol. 2020; 27: 1316-1322 Google Scholar This information helps guide their decision-making. 4 Sternberg K Jordan J Haas MRC et al. Reimagining residency selection: Part 2—a practical guide to interviewing in the post-COVID-19 era. J Grad Med Educ. 2020; 12: 545-549 Google Scholar

Pro: Metabolic Acidosis Should be Corrected With Sodium Bicarbonate in Cardiac Surgical Patients

METABOLIC ACIDOSIS, a commonly encountered acute management challenge during cardiac surgery, is typically a symptom of tissue hypoperfusion. It has many etiologies, though up to 30% of total cardiac cases have been associated with hyperlactatemia. 1 Mak NT Iqbal S de Varennes B et al. Outcomes of post-cardiac surgery patients with persistent hyperlactatemia in the intensive care unit: A matched cohort study. J Cardiothorac Surg. 2016; 11: 33 Crossref PubMed Scopus (19) Google Scholar Hypothermia, rewarming, anemia, hypoxia, shock, hypovolemia, ischemia-reperfusion injury, and gut-derived endotoxemia are all potential contributors to tissue hypoperfusion during cardiac surgery. Additionally, vasoconstrictors used commonly during cardiac surgery also may contribute to tissue hypoperfusion. Metabolic acidosis has been associated with increased morbidity and mortality, and an increased need for intraaortic balloon counterpulsation, blood product transfusion, and prolonged intubation and intensive care unit length of stay. 1 Mak NT Iqbal S de Varennes B et al. Outcomes of post-cardiac surgery patients with persistent hyperlactatemia in the intensive care unit: A matched cohort study. J Cardiothorac Surg. 2016; 11: 33 Crossref PubMed Scopus (19) Google Scholar , 2 Toraman F Evrenkaya S Yuce M et al. Lactic acidosis after cardiac surgery is associated with adverse outcome. Heart Surg Forum. 2004; 7: E155-E159 Crossref PubMed Google Scholar , 3 Basaran M Sever K Kafali E et al. Serum lactate level has prognostic significance after pediatric cardiac surgery. J Cardiothorac Vasc Anesth. 2006; 20: 43-47 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar Although exogenous sodium bicarbonate (SB) administration is a common practice for acidosis correction in cardiac surgical patients, its use is highly controversial. In this manuscript, the authors outline the rationale and merits of using SB for the treatment of metabolic acidosis after cardiac surgery.

REPERFUSION PULMONARY EDEMA AFTER RESECTION OF A MALIGNANT SOLITARY FIBROUS TUMOR OF THE PLEURA MANAGED WITH VENOVENOUS EXTRACORPOREAL MEMBRANE OXYGENATION

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Solitary fibrous tumors of the pleura (SFTP) are rare tumors that account for 5% of all primary pleural tumors. SFTP originate from the submesothelial mesenchymal layer of the pleura from primitive fibroblast or mesenchymal cells. Although most are benign and can be cured by complete resection, malignant forms of SFTP are known to recur more frequently. CASE PRESENTATION: A 66-year-old female with history of hypertension and prior resection of an SFTP via median sternotomy in 2004 (pathology unknown) presented with increasing dyspnea on exertion over the previous four weeks, greatly decreasing her functional status. Imaging revealed a large soft tissue mass occupying most of the right hemithorax and displacing the mediastinum to the left (Figure 1). Patient underwent resection of the large right SFTP via a right thoracotomy with lung isolation via a double lumen ET tube. Upon re-expansion of the right lung at the end of the case, patient became acutely hypoxic and hypotensive, with massive bilateral pulmonary edema on bronchoscopy. Condition persisted despite aggressive suctioning and increased ventilatory and vasopressor support, and patient was emergently placed on venovenous (VV) ECMO in the OR via a 21F right femoral vein cannula and a 17F right internal jugular vein cannula. The patient's hypoxia resolved and blood pressure stabilized on vasoactive drips, while massive pulmonary edema resolved gradually through discharge on POD15. Post-op course complicated by tamponade physiology that required emergent pericardiocentesis, AKI requiring hemodialysis (with full recovery), and atrial fibrillation requiring cardioversion, with resultant stabilization in hemodynamics. ECMO support was discontinued on POD3. Final pathology revealed a 22 x 18 x 10.5cm malignant SFTP with 5 mitotic figures per 10 high power fields. DISCUSSION: RPE is characterized by pulmonary edema plus or minus clinical symptoms, sometimes including hemodynamic instability, after rapid re-inflation of a previously collapsed lung. Although almost exclusively described after drainage of pneumo- or hemothorax in the literature [1], this rare phenomenon is the most likely cause of the massive pulmonary edema seen in our patient with long-term lung compression by SFTP. The pathophysiology of RPE likely includes tissue reperfusion, hypoxia, and free radial damage, among other processes, as the mechanism for lung damage and pulmonary edema. Treatment is generally supportive based on the clinical manifestations of RPE, including ECMO in our case and only two other cases reported in the literature [2, 3]. CONCLUSIONS: VV ECMO allows for complete lung rest while providing adequate oxygenation for end organ perfusion, although not without possible complications, most concerning of which are hemorrhagic. This case is the first to demonstrate the successful use of VV ECMO in a very rare case of RPE after resection of a malignant SFTP. REFERENCE #1: Meeker JW, Jaeger AL, Tillis WP. An uncommon complication of a common clinical scenario: exploring reexpansion pulmonary edema with a case report and literature review. J Community Hosp Intern Med Perspect. 2016; 6:32257. REFERENCE #2: Tung YW, Lin F, Yang MS et al. Bilateral developing reexpansion pulmonary edema treated with extracorporeal membrane oxygenation. Ann Thorac Surg 2010; 89:1268-1271. REFERENCE #3: Shires AL, Green TM, Owen HL et al. Case 4--2009. Severe reexpansion pulmonary edema after minimally invasive aortic valve replacement: management using extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth 2009; 23:549-554. DISCLOSURES: No relevant relationships by Ann Defnet, source=Web Response No relevant relationships by Harvey Pass, source=Web Response No relevant relationships by Deane Smith, source=Web Response No relevant relationships by Gerardo Velez, source=Web Response