Parallel veno-venous and veno-arterial extracorporeal membrane circuits for coexisting refractory hypoxemia and cardiovascular failure: a case report

BMC Anesthesiology

Roman Dudaryk¹  Jose R. Navas-Blanco¹  Sofia A. Lifgren¹  Jeffrey Scott²  Matthias Loebe³  Ali Ghodsizad³ 

[1] Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1800 NW 10 Avenue (M-820), 33136, Miami, FL, USA;Department of Critical Care, Miami Transplant Institute, Jackson Memorial Hospital, Miami, FL, USA;Department of Surgery, University of Miami Hospital, Miami Transplant Institute, Jackson Memorial Hospital, Miami, FL, USA;

关键词: Acute respiratory distress syndrome;    Intensive care unit;    Mechanical ventilation;    Extracorporeal membrane oxygenation;   

DOI  :  10.1186/s12871-021-01299-5

来源: Springer

【 摘 要 】

BackgroundThe complexity of extracorporeal membrane oxygenation (ECMO) techniques continues to evolve. Different cannulation methods and configurations have been proposed as a response to a challenging cardiovascular and pulmonary physiology of the patients. The use of parallel ECMO circuits represents a unique and novel approach for patients with refractory respiratory failure and cardiovascular collapse with very large body surface areas.Case presentationWe present the case of a 25-year-old morbidly obese male patient admitted for severe acute respiratory distress syndrome (ARDS) and refractory hypoxemia, requiring institution of double cannulation for veno-venous ECMO. Since his hypoxemia persisted, likely due to insufficient flows given his large body surface area, an additional drainage venous cannula was implemented to provide higher flows, temporarily addressing his oxygenation status. Unfortunately, the patient developed concomitant cardiogenic shock refractory to inotropic support and extracorporeal fluid removal, further worsening his oxygenation status, thus the decision was to institute four-cannulation/parallel-circuits veno-venous and veno-arterial ECMO, successfully controlling both refractory hypoxemia and cardiogenic shock.ConclusionsOur case illustrates a novel and complex approach for combined severe ARDS and cardiovascular collapse through the use of parallel veno-venous and veno-arterial ECMO circuits, and exemplifies the expansion of ECMO techniques and its life-saving capabilities when conservative approaches are futile.

【 授权许可】

CC BY