Successful management by employing situational extracorporeal membrane oxygenation strategies in a patient with acute type A aortic dissection: a case report
-
Published:2023-08-16
Issue:1
Volume:15
Page:
-
ISSN:2090-925X
-
Container-title:Ain-Shams Journal of Anesthesiology
-
language:en
-
Short-container-title:Ain-Shams J Anesthesiol
Author:
Suzuki Kengo, Yoshida KeisukeORCID, Hakozaki Takahiro, Tanaka Shiori, Inoue Satoki
Abstract
Abstract
Background
We successfully treated a case of acute type A aortic dissection in a patient with acute inferior wall infarction as well as severe circulatory and respiratory disorders.
Case presentation
A 69-year-old woman was diagnosed with acute type A aortic dissection. She received emergency partial aortic arch replacement and coronary artery bypass grafting. After the cardiopulmonary bypass, extracorporeal membrane oxygenation (ECMO) with central cannulation was performed due to severe right heart failure and extensive alveolar hemorrhage. Since the surgery, transesophageal echocardiography was used to monitor her hemodynamic status. The positive end-expiratory pressure (PEEP) was managed based on end-expiratory transpulmonary pressure. Replacement of the ECMO circuit was required every 2–3 days due to intra-circuit thrombus, and continuous renal replacement therapy was started on postoperative day (POD) 8. On POD 13, improvement of cardiac function was observed; we therefore attempted closure of the chest and conversion to veno-venous (V-V) ECMO. However, the patient’s hemodynamics were unstable due to diastolic impairment after the chest closure; thus, peripheral veno-arteriovenous (V-AV) ECMO was introduced. The patient was converted to V-V ECMO on POD 16 and weaned from ECMO on POD 17. The patient was extubated on POD 19. She left the intensive care unit with non-invasive ventilation on POD 20.
Conclusions
The favorable outcome in the current case can be attributed to the following three points: (1) appropriate ECMO strategies were employed according to the patient’s condition, (2) the patient’s lung condition improved due to transpulmonary pressure monitoring and fluid balance management from an early stage, and (3) we observed respiratory and hemodynamic status during the 50–90-s circulatory arrest periods that occurred during ECMO circuit changes, and this observation contributed to the evaluation of weaning from ECMO.
Publisher
Egypts Presidential Specialized Council for Education and Scientific Research
Reference8 articles.
1. Al-Fares AA, Ferguson ND, Ma J, Cypel M, Keshavjee S, Fan E, Del Sorbo L (2021) Achieving safe liberation during weaning from VV-ECMO in patients with severe ARDS: the role of tidal volume and inspiratory effort. Chest 160:1704–1713 2. Kowalewski M, Zieliński K, Brodie D, MacLaren G, Whitman G, Raffa GM, Boeken U, Shekar K, Chen YS, Bermudez C, D’Alessandro D, Hou X, Haft J, Belohlavek J, Dziembowska I, Suwalski P, Alexander P, Barbaro RP, Gaudino M, Di Mauro M, Maessen J, Lorusso R (2021) Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock-analysis of the extracorporeal life support organization registry. Crit Care Med 49:1107–1117 3. Mihu MR, Mageka D, Swant LV, El Banayosy A, Maybauer MO, Harper MD, Koerner MM, El Banayosy A (2021) Veno-arteriovenous extracorporeal membrane oxygenation-a single center experience. Artif Organs 45:1554–1561 4. Pappalardo F, Schulte C, Pieri M, Schrage B, Contri R, Soeffker G, Greco T, Lembo R, Müllerleile K, Colombo A, Sydow K, De Bonis M, Wagner F, Reichenspurner H, Blankenberg S, Zangrillo A, Westermann D (2017) Concomitant implantation of Impella® on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock. Eur J Heart Fail 19:404–412 5. Schrage B, Becher PM, Bernhardt A, Bezerra H, Blankenberg S, Brunner S, Colson P, CudemusDeseda G, Dabboura S, Eckner D, Eden M, Eitel I, Frank D, Frey N, Funamoto M, Goßling A, Graf T, Hagl C, Kirchhof P, Kupka D, Landmesser U, Lipinski J, Lopes M, Majunke N, Maniuc O, McGrath D, Möbius-Winkler S, Morrow DA, Mourad M, Noel C, Nordbeck P, Orban M, Pappalardo F, Patel SM, Pauschinger M, Pazzanese V, Reichenspurner H, Sandri M, Schulze PC, Schwinger R HG, Sinning JM, Aksoy A, Skurk C, Szczanowicz L, Thiele H, Tietz F, Varshney A, Wechsler L, Westermann D (2020) Left ventricular unloading is associated with lower mortality in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation: results from an international, multicenter cohort study. Circulation 142:2095–2106
|
|