Fukuda Masataka, Sakai Hiroaki, Koh Keito, Sakuraba Sonoko, Ando Nozomi, Hayashida Masakazu, Kawagoe Izumi
Department of Anesthesiology and Pain Medicine, Juntendo University Hospital, Tokyo, 113-8431, Japan.
Department of Anesthesia, Fujieda Municipal General Hospital, Shizuoka, Japan.
JA Clin Rep. 2023 Oct 7;9(1):65. doi: 10.1186/s40981-023-00656-2.
We report a case in which veno-venous extracorporeal membrane oxygenation (V-V ECMO) saved the life of a patient who developed severe hypoxemia due to unusual unilateral pulmonary edema (UPE) after cardiopulmonary bypass (CPB).
A 69-year-old man underwent aortic valve replacement and coronary artery bypass grafting. Following uneventful weaning off CPB, he developed severe hypoxemia. The ratio of arterial oxygen tension to inspired oxygen fraction (PaO/FiO) decreased from 301 mmHg 5 min after CPB to 42 mmHg 90 min after CPB. A chest X-ray revealed right-sided UPE. Immediately established V-V ECMO increased PaO/FiO to 170 mmHg. Re-expansion pulmonary edema (REPE) was likely, as the right lung remained collapsed during CPB following the accidental opening of the right chest cavity during graft harvesting.
V-V ECMO was effective in improving oxygenation and saving the life of a patient who had fallen into unilateral REPE unusually developing after conventional CPB.
我们报告了一例静脉-静脉体外膜肺氧合（V-V ECMO）挽救患者生命的病例，该患者在体外循环（CPB）后因罕见的单侧肺水肿（UPE）出现严重低氧血症。
一名69岁男性接受了主动脉瓣置换术和冠状动脉搭桥术。在顺利脱离CPB后，他出现了严重低氧血症。动脉血氧分压与吸入氧分数之比（PaO/FiO）从CPB后5分钟的301 mmHg降至CPB后90分钟的42 mmHg。胸部X线显示右侧UPE。立即建立的V-V ECMO使PaO/FiO升至170 mmHg。再膨胀性肺水肿（REPE）很可能发生，因为在移植血管采集过程中右胸腔意外打开后，右肺在CPB期间一直处于萎陷状态。
V-V ECMO有效地改善了氧合，挽救了一名在传统CPB后异常发生单侧REPE患者的生命。
