医学
心源性休克
低氧血症
体外膜肺氧合
急性呼吸窘迫综合征
麻醉
肺
休克(循环)
心脏病学
重症监护医学
内科学
心肌梗塞
作者
Andrew Rosenbaum,J. Kyle Bohman,Kent H. Rehfeldt,John M. Stulak,Richard C. Daly,Allan M. Klompas,Atta Behfar,Suraj Yalamuri
出处
期刊:A&A practice
[Ovid Technologies (Wolters Kluwer)]
日期:2020-03-20
卷期号:14 (6): e01181-e01181
被引量:3
标识
DOI:10.1213/xaa.0000000000001181
摘要
Utilization of venoarterial extracorporeal membrane oxygenation (VA-ECMO) is expanding, but dual VA-ECMO circuits to treat cardiogenic shock with refractory hypoxemia is unreported. We describe the case of combined cardiogenic and distributive shock due to necrotizing pulmonary blastomycosis. After initial central VA-ECMO cannulation, acute respiratory distress syndrome (ARDS) with increasing shunt resulted in significant central hypoxemia due to progressive ventilation-perfusion mismatch. An additional circuit provided complete oxygenation of the high circulating volume. After 4 months on support, he underwent successful heart-lung-kidney transplantation. Dual ECMO circuits are technically feasible and may be advantageous in specific circumstances of high pulmonary shunting resulting in excessive hypoxemia unbalanced with appropriate oxygen delivery.
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