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Clinical effects of veno-venous extra-corporeal membrane oxygenation for acute myocardial infarction

급성심근경색 환자에게 적용된 정맥-정맥 체외막산화기의 임상 효과

  • Kim, Su Wan (Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine) ;
  • Seong, Gil Myeong (Department of Internal Medicine, Jeju National University Hospital) ;
  • Lee, Jae-Geun (Department of Internal Medicine, Jeju National University Hospital)
  • 김수완 (제주대학교 의학전문대학원 흉부외과학교실) ;
  • 성길명 (제주대학교 병원 내과학교실) ;
  • 이재근 (제주대학교 병원 내과학교실)
  • Received : 2018.11.02
  • Accepted : 2018.12.07
  • Published : 2018.12.31

Abstract

Extra-corporeal membrane oxygenation (ECMO) has the potential to rescue patients in cardiac arrest or respiratory failure. ECMO has two systems such as veno-arterial and veno-venous circulation. In cardiac arrest resulting from acute myocardial infarction, veno-arterial ECMO is mandatory for systemic circulation and oxygenation. A 75-year old female patient underwent primary coronary intervention for acute myocardial infarction. Despite successful revascularization, recurrent ventricular tachycardia and heart failure were progressing. We performed a veno-arterial ECMO through the femoral artery and vein, then the patient seemed to be stable clinically. However, laboratory studies, echocardiography, and vital signs indicated multi-organ failure and decreasing cardiac function. We found out an error that we performed veno-venous ECMO instead of veno-arterial ECMO. We added a femoral artery cannula and exchange the circuit system to veno-arterial ECMO. While the systemic circulation seemed to be recovered, the left ventricular function was decreased persistently. A hypovolemia resulting from pulmonary hemorrhage was occurred, which lead to ECMO failure. The patient died of cardiac arrest and multi-organ failure 23 hours after ECMO. Because the color of arterial and venous circuits represent the position and efficacy of ECMO, if unexpected or abnormal circuit colors are detected, prompt and aggressive evaluation for ECMO function is mandatory.

Keywords

References

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