title: Successful weaning from cardiac extracorporeal membrane oxygenation by banding a hemodialysis arteriovenous fistula.
abstract: We report a case in which weaning from cardiac extracorporeal membrane oxygenation (ECMO) was achieved by temporarily occluding the hemodialysis arteriovenous fistula. A 68-year-old man with diabetic nephropathy underwent coronary artery bypass surgery, and cardiac ECMO was used to wean the patient from cardiopulmonary bypass. An ultrasonic flowmeter showed the arteriovenous flow to be over 750 ml/min, which can lead to increased preload on the weakened heart. On the sixth postoperative day, occlusion of the fistula by compression with a soft bandage provided the correct balance between myocardial reserve and shunt volume and hence facilitated successful weaning from cardiac ECMO.
authors.affiliation: Department of Surgery, Jichi Medical School, 3311-1 Yakushiji, Minamikawachi, Kawachi-gun, 329-0498, Tochigi, Japan. tcvhiro@jichi.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Konishi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tezuka
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Misawa
authors.forename: Katsuo
authors.initials: K
authors.lastname: Fuse
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D001026:Coronary Artery Bypass; D020878:Device Removal; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000628:therapy; D015199:Extracorporeal Membrane Oxygenation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D012039:Regional Blood Flow; D006435:Renal Dialysis