Kredel Markus, Kunzmann Steffen, Schlegel Paul-Gerhardt, Wölfl Matthias, Nordbeck Peter, Bühler Christoph, Lotz Christopher, Lepper Philipp M, Wirbelauer Johannes, Roewer Norbert, Muellenbach Ralf M
Department of Anaesthesia and Critical Care, University Hospital of Würzburg, Würzburg, Germany.
Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany.
Am J Case Rep. 2017 Jun 28;18:723-727. doi: 10.12659/ajcr.902485.
BACKGROUND The use of venoarterial extracorporeal membrane oxygenation (va-ECMO) via peripheral cannulation for septic shock is limited by blood flow and increased afterload for the left ventricle. CASE REPORT A 15-year-old girl with acute myelogenous leukemia, suffering from severe septic and cardiogenic shock, was treated by venoarterial extracorporeal membrane oxygenation (va-ECMO). Sufficient extracorporeal blood flow matching the required oxygen demand could only be achieved by peripheral cannulation of both femoral arteries. Venous drainage was performed with a bicaval cannula inserted via the left V. femoralis. To accomplish left ventricular unloading, an additional drainage cannula was placed in the left atrium via percutaneous atrioseptostomy (va-va-ECMO). Cardiac function recovered and the girl was weaned from the ECMO on day 6. Successful allogenic stem cell transplantation took place 2 months later. CONCLUSIONS In patients with vasoplegic septic shock and impaired cardiac contractility, double peripheral venoarterial extracorporeal membrane oxygenation (va-va-ECMO) with transseptal left atrial venting can by a lifesaving option.
背景 经外周插管进行静脉-动脉体外膜肺氧合（va-ECMO）治疗感染性休克时，受血流量及左心室后负荷增加的限制。病例报告 一名15岁急性髓系白血病女孩，患有严重感染性和心源性休克，接受了静脉-动脉体外膜肺氧合（va-ECMO）治疗。仅通过双侧股动脉外周插管才能实现满足所需氧需求的充足体外血流量。通过经左股静脉插入双腔静脉插管进行静脉引流。为实现左心室减负，经皮房间隔造口术在左心房放置了一根额外的引流管（va-va-ECMO）。心脏功能恢复，女孩在第6天脱离ECMO。2个月后成功进行了异基因干细胞移植。结论 对于血管麻痹性感染性休克且心脏收缩功能受损的患者，经房间隔左心房排气的双外周静脉-动脉体外膜肺氧合（va-va-ECMO）可能是一种挽救生命的选择。
