Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
Hebrew University School of Medicine, Jerusalem, Israel.
Am Surg. 2023 Dec;89(12):6254-6256. doi: 10.1177/00031348221114520. Epub 2022 Sep 8.
The use of extracorporeal membrane oxygenation (ECMO) has increased over the course of the SARS-CoV-2 pandemic. Intra-abdominal hypertension resulting in abdominal compartment syndrome (ACS) during ECMO support is a rare but life-threatening complication, with previous case series describing mortality rates of 44%-100%. Bleeding complications, linked to both patient-related and device-related factors, also characterize prolonged ECMO support and have been reported in up to 60% of ECMO patients. We hereby describe a critically ill COVID-19 patient who underwent emergent bed-side decompressive laparotomy for acute ECMO failure related to the development of ACS. The discussion is focused on surgical considerations including the delicate balance between anticoagulation and thrombosis, as anticoagulation-free ECMO support may be required due to hemorrhagic complications.
在 SARS-CoV-2 大流行期间，体外膜肺氧合（ECMO）的使用有所增加。在 ECMO 支持过程中，由于腹内压升高导致腹腔间隔室综合征（ACS）是一种罕见但危及生命的并发症，以前的病例系列报告死亡率为 44%-100%。出血并发症与患者相关和设备相关因素均有关联，也是 ECMO 支持时间延长的特征，据报道，多达 60%的 ECMO 患者会发生这种情况。在此，我们描述了一位重症 COVID-19 患者，他因 ACS 发展导致急性 ECMO 失败而紧急床边减压剖腹术。讨论重点是手术注意事项，包括抗凝和血栓形成之间的微妙平衡，因为由于出血并发症，可能需要无抗凝 ECMO 支持。
