Pediatric cardiorespiratory failure successfully managed with venoarterial-venous extracorporeal membrane oxygenation: a case report
| Autor: | Satoshi Yamaga, Nobuyuki Hirohashi, Kei Suzuki, Shinichiro Ohshimo, Tatsutoshi Shimatani, Yoshiko Kida, Nobuaki Shime, Y Torikoshi, Michihito Kyo |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty medicine.medical_treatment Femoral vein Case Report 030204 cardiovascular system & hematology Extracorporeal 03 medical and health sciences Coronary circulation 0302 clinical medicine Internal medicine medicine Extracorporeal membrane oxygenation Humans Venoarterial Child Cyclophosphamide Heart Failure business.industry Extracorporeal circulation Hematopoietic Stem Cell Transplantation Hemodynamics Anemia Aplastic 030208 emergency & critical care medicine medicine.disease Cannula Femoral Artery Myocarditis medicine.anatomical_structure surgical procedures operative Echocardiography Heart failure Cyclosporine Cardiology Female Jugular Veins Respiratory Insufficiency business Venovenous Immunosuppressive Agents Venous return curve |
| Zdroj: | BMC Pulmonary Medicine |
| ISSN: | 1471-2466 |
| Popis: | Background: Venoarterial-venous extracorporeal membrane oxygenation (VAV ECMO) configuration is a combined procedure of extracorporeal membrane oxygenation (ECMO). The proportion of cardiac and respiratory support can be controlled by adjusting arterial and venous return. Therefore, VAV ECMO can be applicable as a bridging therapy in the transition from venoarterial (VA) to venovenous (VV) ECMO. Case presentation: We present an 11-year-old girl with chemotherapy-induced myocarditis requiring extracorporeal cardiorespiratory support. She showed progressive hypotension, tachycardia, hyperlactemia, and tachypnea under support of catecholamines. Echocardiography showed severe left ventricular hypokinesis with an ejection fraction of 30 %. She was placed on VA ECMO with a drainage catheter from the right femoral vein (19.5 Fr) and a return catheter to the right femoral artery (16.5 Fr). Extracorporeal circulation was initiated at a blood flow of 2.0 L/min (59 mL/kg/min). On day 31, although cardiac function had improved, persistent pulmonary failure made weaning from VA ECMO difficult. We planned transition from VA ECMO to VAV ECMO to ensure gradual tapering of extracorporeal cardiac support while evaluating cardiopulmonary function. An additional return cannula (13.5 Fr) was inserted from the right internal jugular vein, which was connected to the circuit branch from the original returning cannula. We then gradually shifted the blood from the femoral artery to the right internal jugular vein over 24 h. She was successfully switched from VA to VV ECMO via VAV ECMO. Conclusions: VAV ECMO might be an option in ensuring oxygenation to the coronary circulation and allowing time to adequately evaluate cardiac function during transition from VA to VV ECMO. Further investigations using larger cohorts are necessary to validate the efficacy of VAV ECMO as a bridging therapy in the transition from VA to VV ECMO. This work was supported by a JSPS KAKENHI Grant (Number JP 16K09541). |
| Databáze: | OpenAIRE |
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