Open AccessHeparin-free veno-venous extracorporeal membrane oxygenation in a multiple trauma patient
Author(s) -
Youn Young Lee,
Hee Jung Baik,
Heeseung Lee,
Chi Hyo Kim,
Rack Kyung Chung,
Jong In Han,
Hyunyoung Joo,
Jae Hee Woo
Publication year - 2020
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000019070
Subject(s) - medicine , extracorporeal membrane oxygenation , coagulopathy , hypoxemia , anesthesia , respiratory failure , heparin , hypercapnia , life support , intensive care medicine , acidosis , surgery
Rationale: Extracorporeal membrane oxygenation (ECMO) in multiple trauma patients with post-traumatic respiratory failure can be quite challenging because of the need for systemic anticoagulation, which may lead to excessive bleeding. In the last decade, there is a growing body of evidence that veno-venous ECMO (VV-ECMO) is lifesaving in multiple trauma patients with acute respiratory distress syndrome, thanks to technical improvements in ECMO devices. Patient concerns: We report a case of a 17-year-old multiple trauma patient who was drunken and had confused mentality. Diagnoses: She was suffered from critical respiratory failure (life-threatening hypoxemia and severe hypercapnia/acidosis lasting for 70 minutes) accompanied by cardiac arrest and trauma-induced coagulopathy during general anesthesia. Interventions: We decided to start heparin-free VV-ECMO after cardiac arrest considering risk of hemorrhage. Outcomes: She survived with no neurologic sequelae after immediate treatment with heparin-free VV-ECMO. Lessons: Heparin-free VV-ECMO can be used as a resuscitative therapy in multiple trauma patients with critical respiratory failure accompanied by coagulopathy. Even in cases in which life-threatening hypoxemia and severe hypercapnia/acidosis last for >1 hours during CPR for cardiac arrest, VV-ECMO could be considered a potential lifesaving treatment.