Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1800 NW 10 Avenue (M-820), Miami, FL, 33136, USA.
Department of Critical Care, Miami Transplant Institute, Jackson Memorial Hospital, Miami, FL, USA.
BMC Anesthesiol. 2021 Mar 12;21(1):77. doi: 10.1186/s12871-021-01299-5.
The complexity of extracorporeal membrane oxygenation (ECMO) techniques continues to evolve. Different cannulation methods and configurations have been proposed as a response to a challenging cardiovascular and pulmonary physiology of the patients. The use of parallel ECMO circuits represents a unique and novel approach for patients with refractory respiratory failure and cardiovascular collapse with very large body surface areas.
We present the case of a 25-year-old morbidly obese male patient admitted for severe acute respiratory distress syndrome (ARDS) and refractory hypoxemia, requiring institution of double cannulation for veno-venous ECMO. Since his hypoxemia persisted, likely due to insufficient flows given his large body surface area, an additional drainage venous cannula was implemented to provide higher flows, temporarily addressing his oxygenation status. Unfortunately, the patient developed concomitant cardiogenic shock refractory to inotropic support and extracorporeal fluid removal, further worsening his oxygenation status, thus the decision was to institute four-cannulation/parallel-circuits veno-venous and veno-arterial ECMO, successfully controlling both refractory hypoxemia and cardiogenic shock.
Our case illustrates a novel and complex approach for combined severe ARDS and cardiovascular collapse through the use of parallel veno-venous and veno-arterial ECMO circuits, and exemplifies the expansion of ECMO techniques and its life-saving capabilities when conservative approaches are futile.
体外膜肺氧合（ECMO）技术的复杂性不断发展。不同的插管方法和配置被提出，以应对患者具有挑战性的心血管和肺生理。并行 ECMO 回路的使用代表了一种独特而新颖的方法，适用于患有难治性呼吸衰竭和心血管崩溃且体表面积非常大的患者。
我们介绍了一位 25 岁的病态肥胖男性患者的病例，他因严重急性呼吸窘迫综合征（ARDS）和难治性低氧血症入院，需要进行双管插管以进行静脉-静脉 ECMO。由于他的低氧血症持续存在，可能是由于他的体表面积大导致流量不足，因此实施了额外的引流静脉插管以提供更高的流量，暂时解决了他的氧合状态。不幸的是，患者并发了对正性肌力支持和体外液体清除无效的心源性休克，进一步恶化了他的氧合状态，因此决定实施四管/并行回路静脉-静脉和静脉-动脉 ECMO，成功控制了难治性低氧血症和心源性休克。
我们的病例通过使用并行静脉-静脉和静脉-动脉 ECMO 回路，展示了一种针对严重 ARDS 和心血管崩溃的新型复杂方法，并说明了在保守方法无效时，ECMO 技术及其救生能力的扩展。
