Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
Department of Cardiovascular Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
BMC Cardiovasc Disord. 2023 Aug 31;23(1):431. doi: 10.1186/s12872-023-03477-4.
Left ventricular free wall rupture, particularly the blowout type, is still one of the most lethal complications of myocardial infarction and can cause catastrophic cardiac tamponade. Extracorporeal membrane oxygenation (ECMO) is often used to treat haemodynamic instability due to cardiac tamponade. However, elevated pericardial pressure can cause collapse of the right atrium, resulting in inadequate ECMO inflow and preventing the stabilisation of the circulation. Further, it can interfere with the venous return from the superior vena cava (SVC), increasing the intracranial pressure and reducing cerebral perfusion levels.
A 65-year-old man was hospitalised for out-of-hospital cardiac arrest. We used ECMO for cardiopulmonary resuscitation. After the establishment of ECMO, transthoracic echocardiography and left ventriculography revealed massive pericardial effusion. The treatment was supplemented with pericardial drainage since ECMO flow was frequently hampered by suction events. However, the blowout rupture led to the requirement of constant drainage from the pericardial catheter. To tend to this leak, we connected the venous cannula of ECMO and the pericardial drainage catheter. The surgery was performed with stable circulation without suction failure of ECMO. During the course of the intensive care management, the neurological prognosis of the patient was revealed to be poor, and the patient was shifted to palliative care. Unfortunately, the patient died on day 10 of hospitalisation.
We present a case wherein the combination of pericardial drainage and ECMO was used to maintain circulation in a patient with massive pericardial effusion due to cardiac rupture.
左心室游离壁破裂，尤其是爆裂型，仍然是心肌梗死最致命的并发症之一，可导致灾难性的心包填塞。体外膜肺氧合（ECMO）常用于治疗心包填塞引起的血流动力学不稳定。然而，升高的心包压力可导致右心房塌陷，从而导致 ECMO 流入不足，并阻止循环稳定。此外，它会干扰上腔静脉（SVC）的静脉回流，增加颅内压并降低脑灌注水平。
一名 65 岁男性因院外心脏骤停住院。我们使用 ECMO 进行心肺复苏。在建立 ECMO 后，经胸超声心动图和左心室造影显示大量心包积液。由于 ECMO 流量经常受到抽吸事件的阻碍，因此补充了心包引流治疗。然而，爆裂性破裂导致需要持续从心包导管引流。为了处理这个泄漏，我们将 ECMO 的静脉插管和心包引流导管连接起来。手术在循环稳定且 ECMO 无抽吸失败的情况下进行。在重症监护管理过程中，患者的神经预后被揭示为较差，患者被转移到姑息治疗。不幸的是，患者在住院第 10 天死亡。
我们报告了一例患者，由于心脏破裂导致大量心包积液，我们使用心包引流和 ECMO 联合维持循环。
