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ID 48650
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著者
Kyo, Michihito 病院高度救命救急センター 広大研究者総覧
Ohshimo, Shinichiro 大学院医歯薬保健学研究科(医) 広大研究者総覧
Kida, Yoshiko 大学院医歯薬保健学研究科(医) 広大研究者総覧
Shimatani, Tatsutoshi
Torikoshi, Yusuke
Suzuki, Kei 病院高度救命救急センター 広大研究者総覧
Yamaga, Satoshi
Hirohashi, Nobuyuki 原爆放射線医科学研究所 広大研究者総覧
Shime, Nobuaki 大学院医歯薬学保健学研究科(医) 広大研究者総覧
キーワード
Extracorporeal membrane oxygenation
Venoarterial
Venovenous
Myocarditis
抄録(英)
Background: Venoarterial-venous extracorporeal membrane oxygenation (VAV ECMO) configuration is a combined procedure of extracorporeal membrane oxygenation (ECMO). The proportion of cardiac and respiratory support can be controlled by adjusting arterial and venous return. Therefore, VAV ECMO can be applicable as a bridging therapy in the transition from venoarterial (VA) to venovenous (VV) ECMO.
Case presentation: We present an 11-year-old girl with chemotherapy-induced myocarditis requiring extracorporeal cardiorespiratory support. She showed progressive hypotension, tachycardia, hyperlactemia, and tachypnea under support of catecholamines. Echocardiography showed severe left ventricular hypokinesis with an ejection fraction of 30 %. She was placed on VA ECMO with a drainage catheter from the right femoral vein (19.5 Fr) and a return catheter to the right femoral artery (16.5 Fr). Extracorporeal circulation was initiated at a blood flow of 2.0 L/min (59 mL/kg/min). On day 31, although cardiac function had improved, persistent pulmonary failure made weaning from VA ECMO difficult. We planned transition from VA ECMO to VAV ECMO to ensure gradual tapering of extracorporeal cardiac support while evaluating cardiopulmonary function. An additional return cannula (13.5 Fr) was inserted from the right internal jugular vein, which was connected to the circuit branch from the original returning cannula. We then gradually shifted the blood from the femoral artery to the right internal jugular vein over 24 h. She was successfully switched from VA to VV ECMO via VAV ECMO.
Conclusions: VAV ECMO might be an option in ensuring oxygenation to the coronary circulation and allowing time to adequately evaluate cardiac function during transition from VA to VV ECMO. Further investigations using larger cohorts are necessary to validate the efficacy of VAV ECMO as a bridging therapy in the transition from VA to VV ECMO.
内容記述
This work was supported by a JSPS KAKENHI Grant (Number JP 16K09541).
掲載誌名
BMC Pulmonary Medicine
16巻
開始ページ
119
出版年月日
2016-08-12
出版者
BioMed Central Ltd.
ISSN
1471-2466
出版者DOI
PubMedID
言語
英語
NII資源タイプ
学術雑誌論文
広大資料タイプ
学術雑誌論文
DCMIタイプ
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application/pdf
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権利情報
© 2016 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
関連情報URL
部局名
医歯薬保健学研究科
原爆放射線医科学研究所
病院