Heparin-free veno-venous extracorporeal membrane oxygenation in a multiple trauma patient: A case report.

Abstract

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.

• Authors: Youn Young Lee, Hee Jung Baik, Heeseung Lee, Chi Hyo Kim, Rack Kyung Chung, Jong In Han, Hyunyoung Joo, Jae Hee Woo
• Journal: Medicine (Medicine (Baltimore)) Vol. 99 Issue 5 Pg. e19070 (Jan 2020) ISSN: 1536-5964 [Electronic] United States
• PMID: 32000456 (Publication Type: Case Reports, Journal Article)

Topics

• Adolescent
• Blood Coagulation Disorders (therapy)
• Extracorporeal Membrane Oxygenation (methods)
• Female
• Heart Arrest (therapy)
• Humans
• Multiple Trauma (therapy)
• Respiratory Distress Syndrome (therapy)