Uso de suporte hemodinâmico e respiratório por meio de oxigenação extracorpórea por membrana (ECMO) venoarterial em um paciente politraumatizado

Abstract

Uso de suporte hemodinâmico e respiratório por meio de oxigenação extracorpórea por membrana (ECMO) venoarterial em um paciente politraumatizado INTRODUCTIONThe use of extracorporeal membrane oxygenation (ECMO) as respiratory support has been widely acknowledged as a rescue technique for refractory hypoxemia in H1N1-infected patients.(1) Recently, our institution adopted the use of ECMO in the intensive care unit (ICU) for selected refractory cardiopulmonary dysfunction cases.In the venoarterial modality, venous blood is oxygenated and pumped back into the arterial system, providing total/nearly total cardiorespiratory support. This method is mostly used in patients who are difficult to wean from cardiopulmonary bypass following acute myocardial infarction or in cases of refractory cardiac arrest. (2) Few investigators have reported the use of ECMO for simultaneous posttraumatic cardiac and pulmonary dysfunctions. (3,4) In this article, we report the case of a 48-year-old male patient with cardiogenic shock and hypoxemia due to cardiac and pulmonary contusions, who was successfully supported by venoarterial ECMO until cardiorespiratory recovery. CASE REPORTA 48-year-old male patient, with no previous comorbidities, was brought to the emergency service of Hospital das Clínicas after a serious traffic accident (automobile versus motorcycle). The patient was a motorcycle rider who was not wearing a helmet. At the accident site, he had an oxygen saturation of ABSTRACTThere are few reports in the literature regarding the use of venoarterial extracorporeal membrane oxygenation (ECMO) for double-dysfunction from both heart and lung contusions in polytrauma patients. This article reports a 48-year-old patient admitted after a traffic accident. He rapidly progressed to shock with low cardiac output due to myocardial contusion and refractory hypoxemia due to pulmonary contusion, an unstable chest wall and bilateral pneumothorax. ECMO was an effective rescue procedure in this dramatic situation and was successfully discontinued on the fourth day after the trauma. The patient also developed an extensive brain infarction and eventually died on the seventh day after admission. Conflicts of interest:The ECMO membranes were donated by Maquet Cardiopulmonary.

Use of venoarterial extracorporeal membrane oxygenation in fulminant chagasic myocarditis as a bridge to heart transplant

“…( 7 , 8 ) In the face of heart function improvement, the mechanical support device can be progressively withdrawn, but when cardiac function impairment is maintained, the treatment of choice would be a long-term device or heart transplant. ( 9 , 10 ) In a 6-month follow-up outpatient consult, the patient presented himself in good health, ratifying the cost-utility of this procedure in Brazil. ( 10 )…”