Galvagno Samuel M, Shah Nirav G, Cornachione Christopher R, Deatrick Kristopher B, Mazzeffi Michael A, Menaker Jay
University of Maryland School of Medicine, Baltimore, MD, USA.
Program in Trauma and Department of Anesthesiology, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.
Perfusion. 2019 Sep;34(6):523-525. doi: 10.1177/0267659119826828. Epub 2019 Feb 11.
Diffuse alveolar damage is the histologic hallmark for the acute phase of acute respiratory distress syndrome and can occasionally present as diffuse alveolar hemorrhage.
We report a patient with diffuse alveolar hemorrhage and acute respiratory distress syndrome requiring veno-venous extracorporeal life support for 210 days, who was successfully treated for a period of 130 consecutive days without intravenous anticoagulation.
Although there are a few brief reports detailing long extracorporeal life support runs, the literature is largely devoid of data regarding long-term extracorporeal life support without full systemic anticoagulation. Regular inspection of the extracorporeal membrane oxygenation circuit is critical because externally visible thrombi may predict internal thrombus generation with the potential for systemic embolization or abrupt oxygenator failure. In our case, multiple circuit and oxygenators changes were required.
We have demonstrated that a patient with a contraindication for systemic anticoagulation can safely have veno-venous extracorporeal life support for prolonged periods without catastrophic thrombotic complications.
弥漫性肺泡损伤是急性呼吸窘迫综合征急性期的组织学特征，偶尔可表现为弥漫性肺泡出血。
我们报告了一名患有弥漫性肺泡出血和急性呼吸窘迫综合征的患者，该患者需要静脉-静脉体外膜肺氧合支持210天，在未进行静脉抗凝的情况下成功治疗了130天。
尽管有一些简短的报告详细描述了长时间的体外膜肺氧合支持，但文献中大多缺乏关于在未进行充分全身抗凝的情况下长期进行体外膜肺氧合支持的数据。定期检查体外膜肺氧合回路至关重要，因为外部可见的血栓可能预示着内部血栓的形成，存在发生全身栓塞或氧合器突然故障的可能性。在我们的病例中，需要多次更换回路和氧合器。
我们证明了一名存在全身抗凝禁忌证的患者可以在不发生灾难性血栓并发症的情况下安全地接受长时间的静脉-静脉体外膜肺氧合支持。
