Jamal Tamer, Shalabi Amjad, Grosman-Rimon Liza, Ghanim Diab, Amir Offer, Kachel Erez
Cardiac Surgery Department, B Padeh Medical Center, Poriya, Israel.
Department of Cardiac Surgery, Sheba Medical Centre, 5265601, Tel Hashomer, Israel.
J Cardiothorac Surg. 2020 Jun 17;15(1):143. doi: 10.1186/s13019-020-01188-x.
High voltage electrical injury (HVEI) of more than 1000 V is a potentially devastating form of a multisystem injury associated with high morbidity and mortality. We present the first case of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a life saving device for treating a patient with severe cardiogenic shock after a high voltage electrical injury.
A 26-year-old male sustained HVEI while working with a concrete mixer pump that came in contact with a high voltage cable of 10,000 V. He was immediately disconnected from the mixer pump, underwent cardiopulmonary resuscitation and was transported to the nearest medical centre with severe cardiogenic shock with an ejection fraction (EF) of < 10%. Upon arrival, he was in critical condition, sedated and mechanically ventilated, haemodynamically unstable and supported by intravenous (IV) inotropes after a few events of ventricular fibrillation, with an electrical entry point on the left hand and an exit point located on his right leg. Blood pH was 6.8, PCO 53 mmHg, PaO of 57 mmHg, lactate 8 mmol/L, and Troponin 38,000 ng/dl. The EF was 10% with global severe left ventricular dysfunction. During cardiopulmonary resuscitation (CPR), including cardiac massage and few electrical shocks, he was immediately connected to the VA-ECMO via open right femoral approach with distal arterial leg perfusion. He was treated with IV broad spectrum antibiotics, and high volume fluids to prevent rhabdomyolysis-induced acute kidney injury, total parenteral nutrition, topical silver sulfadiazine cream, and Granuflex for severe electrical burns. He was gradually weaned from inotropes over the next 3 days, during which his clinical condition and bloodwork improved tremendously. His EF gradually increased to 50% and he was weaned from the VA-ECMO, and underwent decannulation 86 h after initialization. He was discharged on day 27 without any sequelae.
The VA-ECMO treatment can be a lifesaving device for treating severe cardiogenic shock caused by high voltage electrical injury, and should be considered while treating these "high-mortality risk" patients.
超过1000V的高压电损伤（HVEI）是一种潜在的毁灭性多系统损伤形式，发病率和死亡率都很高。我们报告首例将静脉-动脉体外膜肺氧合（VA-ECMO）作为挽救生命的设备用于治疗高压电损伤后严重心源性休克患者的病例。
一名26岁男性在操作与10000V高压电缆接触的混凝土搅拌输送泵时遭受高压电损伤。他立即与搅拌输送泵脱离接触，接受了心肺复苏，并被送往最近的医疗中心，当时处于严重心源性休克状态，射血分数（EF）<10%。到达时，他病情危急，处于镇静和机械通气状态，血流动力学不稳定，在发生几次室颤后通过静脉注射（IV）血管活性药物维持，左手有电流入口点，右腿有电流出口点。血液pH值为6.8，二氧化碳分压（PCO）53mmHg，动脉血氧分压（PaO）57mmHg，乳酸8mmol/L，肌钙蛋白38000ng/dl。EF为10%，伴有严重的全心左心室功能障碍。在心肺复苏（CPR）期间，包括心脏按压和几次电击除颤，通过开放右股动脉入路并进行远端腿部动脉灌注，他立即被连接到VA-ECMO。他接受了静脉注射广谱抗生素、大量液体以预防横纹肌溶解诱导的急性肾损伤、全胃肠外营养、外用磺胺嘧啶银乳膏以及用于严重电烧伤的Granuflex治疗。在接下来的3天里，他逐渐停用血管活性药物，在此期间他的临床状况和血液检查结果有了极大改善。他的EF逐渐增加到50%，并停用了VA-ECMO，在启动后86小时进行了拔管。他在第27天出院，没有任何后遗症。
VA-ECMO治疗可以作为治疗高压电损伤所致严重心源性休克的挽救生命的设备，在治疗这些“高死亡风险”患者时应予以考虑。
