Leucocyte depletion in a drowning victim during rewarming with extracorporeal circulation may limit pulmonary oedema

Abstract

Introduction: We report two drowning victims with hypothermic circulatory arrest who were resuscitated with the use of extracorporeal circulation (ECC). The first patient developed severe post–bypass pulmonary oedema and inspired us to use a leucocyte–depletion filter in the second patient to attenuate leucocyte–mediated pulmonary reperfusion injury. Methods: In the first patient, a standard extracorporeal circuit was used. In the second patient, systemic leucocyte depletion was applied using leucocyte–depletion filters (Pall RS 1, Pall, Portsmouth, UK), in the venous side of the extracorporeal circuit. Circulating leucocyte counts were measured and arterial blood gas analysis and chest X–rays were performed. Results: Both patients showed a decrease of the circulating leucocyte counts during rewarming and had nearly similar leucocyte counts on arrival at the intensive care unit (ICU). The first patient developed severe pulmonary oedema, with poor arterial blood gases, whereas the second patient, who had leucocyte–depletion by filtration, did not develop severe pulmonary oedema, and had good arterial blood gases. Conclusion: Profound leucocyte–depletion by means of filtration may have contributed to limit leucocyte–mediated pulmonary reperfusion injury.