Postoperative extracorporeal membrane oxygenation for severe intraoperative SIRS 10 h after multiple trauma.
A 34-yr-old male suffered multiple trauma in a road traffic accident. He required right thoracotomy and laparotomy to control exanguinating haemorrhage, and received 93 u blood and blood products. Intraoperatively, he developed severe systemic inflammatory response syndrome (SIRS) with coagulopathy and respiratory failure. At the end of the procedure, the mean arterial pressure (MAP) was 40 mm Hg, arterial blood gas analysis showed a pH of 6.9, Pa(CO(2)) 12 kPa, and Pa(O(2)) 4.5 kPa, and his core temperature was 29 degrees C. There was established disseminated intravascular coagulation. The decision was made to stabilize the patient on veno-venous extracorporeal membrane oxygenation (ECMO) only 10 h after the accident, in spite of the high risk of haemorrhage. The patient was stabilized within 60 min and transferred to the intensive care unit. He was weaned off ECMO after 51 h. He had no haemorrhagic complications, spent 3 weeks in the intensive care unit, and has made a good recovery.
Schupp
M
M
Department of Anaesthesia, Glenfield Hospital, University Hospitals Leicester, Groby Road, Leicester LE3 9QP, UK.
Swanevelder
J L C
JL
Peek
G J
GJ
Sosnowski
A W
AW
Spyt
T J
TJ
D000063:Accidents, Traffic; D000328:Adult; D004211:Disseminated Intravascular Coagulation / Q000628:therapy; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D008297:Male; D009104:Multiple Trauma / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D012131:Respiratory Insufficiency / Q000628:therapy; D018746:Systemic Inflammatory Response Syndrome / Q000628:therapy*