Akademik Veri Yönetim Sistemi
22nd International Intensive Care Symposium, İstanbul, Türkiye, 3 - 04 Mayıs 2019, (Yayınlanmadı)
INTRODUCTION: The use of extracorporeal membrane oxygenation (ECMO) systems is increasing in patients with severe cardiac and respiratory failureHere, we aimed to share our experience with Veno-Arterio-Venous (V-A-V) ECMO on the development of differential hypoxia during ECMO application in our pregnant patient who diagnosed pancreatitis.
CASE: 37 years old, 34 weeks pregnant woman was admitted to the emergency department with abdominal pain. Amylase-lipase elevation and hypertriglyceridemia (7620 mg / dl) were observed in the patient.She was hospitalized in the gastroenterology service with a diagnosis of non-biliary pancreatitis.During follow-up, placental detachment developed and was taken to ICU after emergency C / S. Lipoferez due to hypertriglyceridemia; HDF and hemoperfusion were applied.ECMO was planned due to ARDS and resistant hypoxemia and cannulation was performed from right femoral artery and vein. The patient developed cardiac arrest, V-A ECMO was started, response was obtained.On the first day of follow-up, V-A-V ECMO was switched to the patient with differential hypoxia by adding venous cannula from the right internal jugular vein.Hypoxemia of the patient recovered successfully on the 19th day of ECMO.She was extubated on the third day after ECMO process. Abdominal strain and infectious drainage were ongoing.The patient who developed respiratory distress was intubated.There was no evidence of mesenteric embolism in angiography and an emergency laparotomy was performed.Widespread abdominal necrosis was observed.On the 46th day of hospitalization, cardiac arrest developed and died.
DISCUSSION: The ECMO system usually includes veno-venous for respiratory support and two large cannulae for veno-arterial support for circulatory support (dual cannulation).In recent litarature, the use of veno-arterio-venous ECMO system with three broad cannulae has been reported in rare cases. In ECMO, myocardial and cerebral oxygenation is compromised due to the phenomenon called differential hypoxia (two-circulatory syndrome).We believe that V-A-V cannulation is a preferable method to improve the efficacy of ECMO treatment in selected patients.