Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/12322
Title: Extracorporeal membrane modality conversions.
Authors: Chan-Dominy, A C F;Anders, M;Millar, Jeremy L;Horton, S;Best, D;Brizard, C;D'Udekem, Y;Hilton, A;Butt, W
Affiliation: Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC 3052, Australia marc.anders@rch.org.au.
Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, VIC 3052, Australia.
Department of Intensive Care, Austin Hospital, Melbourne, VIC 3084, Australia.
Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC 3052, Australia.
Issue Date: 28-Jul-2014
Citation: Perfusion 2014; 30(4): 291-4
Abstract: We report the case of a patient with cardiovascular and respiratory failure due to severe anaphylaxis requiring multiple extracorporeal membrane oxygenation (ECMO) cannulation strategies to provide adequate oxygen delivery and ventilatory support during a period of rapid physiological change. ECMO provides partial or complete support of oxygenation-ventilation and circulation. The choice of which ECMO modality to use is governed by anatomical (vessel size, cardiovascular anatomy and previous surgeries) and physiological (respiratory and/or cardiac failure) factors. The urgency with which ECMO needs to be implemented (emergency cardiopulmonary resuscitation (eCPR), urgent, elective) and the institutional experience will also influence the type of ECMO provided. Here we describe a 12-year-old schoolgirl who, having been resuscitated with peripheral veno-venous (VV) ECMO for severe hypoxemia due to status asthmaticus in the setting of acute anaphylaxis, required escalation to peripheral veno-arterial (VA) ECMO for precipitous cardiovascular deterioration. Insufficient oxygen delivery for adequate cellular metabolic function and possible cerebral hypoxia due to significant differential hypoxia necessitated ECMO modification. After six days of central (transthoracic) VA ECMO support and 21 days of intensive care unit (ICU) care, she made a complete recovery with no neurological sequelae. The use of ECMO support warrants careful consideration of the interplay of a patient's pathophysiology and extracorporeal circuit dynamics. Particular emphasis should be placed on the potential for mismatch between cardiovascular and respiratory support as well as the need to meet metabolic demands through adequate cerebral, coronary and systemic oxygenation. Cannulation strategies occasionally require alteration to meet and anticipate the patient's evolving needs.
Internal ID Number: 25070898
URI: http://ahro.austin.org.au/austinjspui/handle/1/12322
DOI: 10.1177/0267659114544486
URL: http://www.ncbi.nlm.nih.gov/pubmed/25070898
Type: Journal Article
Subjects: ECMO
anaphylaxis
extracorporeal membrane oxygenation
resuscitation
shock
status asthmaticus
Appears in Collections:Journal articles

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