| Autor: |
Simone, Brück, Christian, Skrabal, Andreas, Liebold, Georg, Mols, Karl, Träger |
| Jazyk: |
němčina |
| Rok vydání: |
2019 |
| Předmět: |
|
| Zdroj: |
Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS. 54(4) |
| ISSN: |
1439-1074 |
| Popis: |
A 46-year-old woman on oral contraceptives developed an intrahepatic hematoma due to a benign hepatic tumor. As an incidental finding, a computed tomography showed a pulmonary embolism. Unfractionated heparin was given in a prophylactic dosing in an attempt to balance the risk of further intrahepatic bleeding with that of thrombosis. Ten days later, the patient developed a second pulmonary embolism along with acute right heart failure requiring cardiopulmonary resuscitation. As a sufficient circulation and oxygenation could not be reestablished, a veno-arterial extracorporeal membrane oxygenation (ECMO) was installed. An ELISA-Test, detecting PF4-Heparin associated antibodies, resulted in a positive result for a type II heparin induced thrombocytopenia even in the absence of thrombocytopenia. After hemodynamic and pulmonary stabilization, six days after ECMO-support the cannula was scheduled to be removed. On removal of the venous cannula the patient developed another massive pulmonary embolism with cardiac arrest which led to immediate reinstallation of va-ECMO. Under therapeutic anticoagulation using argatroban the ECMO support continued until the patient was on day 17 successfully weaned.Bei einer 46-jährigen Patientin zeigt sich neben einem neu aufgetretenen Leberhämatom zusätzlich noch eine Lungenarterienembolie, so dass eine Antikoagulation mit Heparin begonnen wird. Daraufhin kommt es zu einer heparininduzierten Thrombozytopenie Typ II mit fulminanter Lungenarterienembolie, die eine Therapie mit einer venoarteriellen extrakorporalen Membranoxygenierung (va-ECMO) notwendig macht. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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