Promising method for management of venoarterial extracorporeal membrane oxygenation: A case of severe heart failure successfully stabilized by “high-flow/vasodilation method”
2018
Abstract We report the case of a 58-year-old man with dilated cardiomyopathy who was hospitalized because of worsening heart failure. As his symptoms were refractory even with the administration of inotropes, he was given peripheral venoarterial
extracorporeal membrane oxygenation(VA-ECMO) upon transfer to our hospital. On admission, serum creatinine was 2.62 mg/dL and total bilirubin 10.8 mg/dL. The
cannulasinserted were 16-Fr for infusion and 21-Fr for drainage. When the blood flow was increased to 2.14 L/min/m 2 to improve organ dysfunction, the aortic valve became continuously close with the
mean arterial pressureof 85 mmHg. Therefore, we administrated
vasodilatorsto decrease
mean arterial pressure, or left ventricular
afterload, which achieved opening aortic valve continuously. After the
cannulasizes were scaled up to 18Fr for infusion and 24Fr for drainage to gain further blood flow, the aortic valve opened continuously and mean pulmonary pressure decreased. Our strategy to maintain adequate flow rate of VA-ECMO using
vasodilator, “high-flow/
vasodilationmethod”, achieved hemodynamic stability. Additionally, the concentration of serum creatinine and total bilirubin gradually decreased to within the normal range, although the patient succumbed 58 days after transfer to our hospital. Learning objective: Venoarterial
extracorporeal membrane oxygenation(VA-ECMO) is often used as a first-line mechanical circulatory support in patients with severe heart failure. However, its management is difficult and not established. We discuss the efficacy and potency of our “high-flow/
vasodilationmethod” in the management of VA-ECMO.>
Keywords:
-
Correction
-
Source
-
Cite
-
Save
5
References
3
Citations
NaN
KQI