Fig. 2

Imaging setup for perfusion scintigraphy with ^99mTc-HMPAO of the patient on vaECMO (A), with gamma camera (red arrow), portable respirator (green arrow) and ECMO pump/oxygenator (yellow arrow). The dynamic acquisition (B) shows inflow of the tracer from the left arm (12s after injection), appearing in the carotid and subclavian arteries 32s after tracer injection (red arrows) and in the extraaxial soft tissues of the head. Static planar images acquired after 30 min (C) do not show tracer uptake in the brain (dotted line), which can be confirmed by tomographic SPECT imaging (D, examplary coronal views). Transcranial Duplex-sonography (E). Circulation arrest in the left middle cerebral artery (MCA). Right MCA, distal carotid artery, bilateral V4 segments and basilar artery showed the same pattern