ECMO for intractable status asthmaticus following atracurium
| Autor: | Antonio Pesenti, Michela Bombino, Vittorio Scaravilli, Annalisa Benini, Uta Emmig, Nicolò Patroniti, Giacomo Grasselli, Alberto Zanella, Daniele Ceriani |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Nephrology medicine.medical_specialty medicine.medical_treatment Status Asthmaticus Biomedical Engineering Medicine (miscellaneous) Bronchial spasm Bronchospasm Hypercapnia Biomaterials 03 medical and health sciences Extracorporeal Membrane Oxygenation 0302 clinical medicine Internal medicine medicine Extracorporeal membrane oxygenation Humans Anaphylaxis business.industry Respiratory insufficiency Atracurium Female Neuromuscular Nondepolarizing Agents Respiratory Insufficiency Cardiology and Cardiovascular Medicine Thyroidectomy 030208 emergency & critical care medicine medicine.disease Cardiac surgery Surgery surgical procedures operative Anesthesia Hypercapnic Acidosis medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Artificial Organs. 20:178-181 |
| ISSN: | 1619-0904 1434-7229 |
| Popis: | Intraoperative allergic reactions are rare but serious events associated with increased morbidity and mortality. We report the salvage of intraoperative anaphylaxis leading to extreme hypercapnic respiratory failure by veno-venous extracorporeal membrane oxygenation (ECMO). A 38-year-old woman undergoing thyroidectomy developed intractable bronchospasm after administration of atracurium, leading to extreme hypercapnic respiratory failure (PaCO2 > 250 mmHg, pH 6.773). After the failure of conventional medical therapy and ventilatory optimization, the patient was connected to a veno-venous ECMO circuit. PaCO2 of 45.6 mmHg and pH of 7.25 were achieved in 1 h, by slowly increasing sweep gas flows up to 3.5 L/min and using continuous end-tidal CO2 monitoring to gauge the procedure. After extubation and disconnection from ECMO, the patient was discharged on the 6th day without sequelae. Rapid reversal of extreme hypercapnic acidosis by ECMO was feasible, without any neurologic sequelae. Veno-venous ECMO support may be a valuable option for the salvage of intraoperative anaphylaxis. |
| Databáze: | OpenAIRE |
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