Application of veno-arterial-venous extracorporeal membrane oxygenation in differential hypoxia

  • Joon Hyouk Choi Deparment of Cardiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea, Republic of.
  • Su Wan Kim | 95swan@hanmail.net Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea, Republic of.
  • Young Uck Kim Deparment of Cardiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea, Republic of.
  • Song-Yi Kim Deparmtent of Cardiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea, Republic of.
  • Ki-Seok Kim Deparment of Cardiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea, Republic of.
  • Seung-Jae Joo Deparment of Cardiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea, Republic of.
  • Jung Seok Lee Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea, Republic of.

Abstract

Veno-arterial extracorporeal membrane oxygenation (ECMO) through the femoral vein and artery may cause differential hypoxia, i.e., lower PaO2 in the upper body than in the lower body, because of normal cardiac output with severe impairment of pulmonary function. Hereby, we report the diagnosis and the treatment of differential hypoxia caused by veno-arterial ECMO. A 39-year-old man received cardiopulmonary resuscitation from a cardiac arrest due to acute myocardial infarction. Even after more than 30 min of resuscitation, spontaneous circulation had not resumed. Next, we performed veno-arterial ECMO through the femoral artery and vein, and the patient recovered consciousness on the second day of ECMO. On day 5 of ECMO, he lost consciousness again and presented a generalized tonic-clonic seizure, and an electroencephalogram showed delta waves suggesting diffuse cerebral cortical dysfunction. While an echocardiogram revealed improvements in myocardial function, a follow up chest radiograph showed increasing massive parenchymal infiltrations, and gas analysis of blood from the right radial artery revealed severe hypoxemia. These findings indicated a definite diagnosis of differential hypoxia, and therefore, we inserted a 17-Fr cannula into the left subclavian vein as a return cannula. The patient’s consciousness and pulmonary infiltrations were improved 2 days after veno-arterial-venous ECMO, and the electroencephalogram showed normal findings. To our knowledge, this is the first report of successful clinical management of differential hypoxia. We suggest that veno-arterial-venous ECMO could be the treatment of choice for differential hypoxia resulting from veno-arterial ECMO.

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Published
2014-11-04
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Section
Case Reports
Keywords:
Brain, Extracorporeal membrane oxygenation, Lungs, Pulmonary function
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How to Cite
Choi, J. H., Kim, S. W., Kim, Y. U., Kim, S.-Y., Kim, K.-S., Joo, S.-J., & Lee, J. S. (2014). Application of veno-arterial-venous extracorporeal membrane oxygenation in differential hypoxia. Multidisciplinary Respiratory Medicine, 9(1). https://doi.org/10.4081/mrm.2014.390