The Journal of extra-corporeal technology
-
J Extra Corpor Technol · Jun 2011
Case ReportsAdult respiratory distress syndrome caused by 2009 H1N1 influenza during pregnancy: success of ECMO for both the mother and the child.
Extracorporeal membrane oxygenation (ECMO) is a technique that provides support to selected patients with severe respiratory failure. During the 2009 H1N1 influenza infection outbreak, ECMO was used with a good impact on survival for pregnant women, who are at higher risk of H1N1 influenza infection. However, there is little information about the survival of fetus post-ECMO therapy in the literature. ⋯ The outcome was good both for the mother and her fetus. At 1-year follow-up, her child had no neurological or clinical abnormalities. We conclude that ECMO can be used safely during pregnancy with a good neurological and clinical outcome for the fetus.
-
J Extra Corpor Technol · Jun 2011
Case ReportsMassive systemic air embolism during extracorporeal membrane oxygenation support of a neonate with acute respiratory distress syndrome after cardiac surgery.
Extracorporeal membrane oxygenation (ECMO) is universally accepted as a potential lifesaving therapy for neonates suffering severe cardiorespiratory failure, with survival reported as 81% weaning off ECMO and 69% to hospital discharge in this population. Although ECMO may reduce mortality in certain neonatal patients, it is associated with significant complications. ⋯ We present a fatal case of neonatal systemic air embolism leading to massive entrainment of air into the ECMO venous return cannula of a neonatal patient with acute respiratory distress syndrome following repair of obstructed total anomalous pulmonary venous connection. We describe the pathophysiology and presentation of this rare condition and the importance of early recognition, due to its high mortality rate.
-
J Extra Corpor Technol · Jun 2011
Case ReportsSuccessful use of venovenous extracorporeal membrane oxygenation for complicated H1N1 pneumonia refractory to mechanical ventilation.
In April 2009, novel H1N1 influenza A pneumonia was initially identified in young adults by the Mexican Health Ministry. Previously healthy patients progressing to multisystem organ failure were common. Worldwide, hospitals reported surges in intensive care admissions during the initial phase of the pandemic. ⋯ Our Institutional Review Board waived the need for consent. Prompt initiation of VV ECMO resulted in rapid clinical improvement, radiographic resolution of diffuse consolidation, and return of full neurocognitive function. For children with rapidly progressive respiratory distress on conventional ventilation, VV ECMO can be used to improve outcomes when initiated early in the disease process even in children with a significant co-morbidity.
-
J Extra Corpor Technol · Jun 2011
Case ReportsSevere thrombotic and bleeding complications in a baby with heterozygous factor V Leiden and acquired von Willebrand disease on ECMO.
We aim to present the case of a 5-week-old girl with severe respiratory failure placed on veno-venous extracorporeal membrane oxygenation (ECMO) that was then switched to veno-arterial ECMO. She required up to 60 units/kg/hr of heparin to keep her heparin level within the target range at .3-.7 units/mL. During the ECMO course, substantial thrombus formation was observed within the venous site of the ECMO cannula, which led to two circuit changes on ECMO day 9 and day 20. ⋯ Her von Willebrand panel revealed absence of high molecular weight multimers. Further coagulation workup was prompted which revealed heterozygosity for factor V Leiden. The patient developed severe pulmonary hemorrhages and ECMO was discontinued on day 40.
-
J Extra Corpor Technol · Mar 2011
Extracorporeal membrane oxygenation--understanding the evidence: CESAR and beyond.
Extracorporeal membrane oxygenation (ECMO) has been used for nearly 40 years for treating life threatening respiratory failure. Two historic randomized trials in adults, conducted using outdated techniques, did not show a survival advantage. However, recent case series and a large randomized controlled trial have demonstrated good outcomes from ECMO in adults. ⋯ Treatments such as ECMO are extremely difficult to assess by randomized controlled trials. Observational data demonstrate excellent results from ECMO for treating patients with life threatening respiratory failure caused by pandemic H1N1 influenza, and have greatly influenced practice in Australia and New Zealand. Used as part of a multi-modal approach to treating acute respiratory failure in adults, ECMO is an important, potentially life saving, technique.