title: Resuscitation of fat embolism syndrome with extracorporeal membrane oxygenation.
abstract: Embolization of marrow fat appears to be an inevitable consequence of long bone fractures. Pulmonary fat embolism (FE) with cardiovascular collapse is associated with a high mortality rate because of acute right ventricular failure and hypoxia. Immediate and appropriate resuscitation is required to prevent sudden death. Although extracorporeal membrane oxygenation (ECMO) has been used for a multitude of applications involving respiratory and circulatory collapse, its full potential as a standard conventional therapy has yet to be exploited. Herein, we describe the successful use of veno-venous (V-V) ECMO in a trauma patient who initially presented with fractures of the right ulna and femur. After surgery, the patient rapidly decompensated despite massive ventilatory support and was placed on ECMO. ECMO support lasted approximately 120 hours followed by an uneventful recovery and discharge 10 days later.
authors.affiliation: Vanderbilt University Medical Center, Childrens Hospital, ECMO Department, Nashville, Tennessee 37232, USA. david.webb@vanderbilt.edu
authors.forename: David P
authors.initials: DP
authors.lastname: Webb
authors.forename: Wes A
authors.initials: WA
authors.lastname: McKamie
authors.forename: John B
authors.initials: JB
authors.lastname: Pietsch
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation; D004620:Embolism, Fat / Q000209:etiology / Q000628:therapy*; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation; D005264:Femoral Fractures / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000209:etiology / Q000628:therapy*; D013577:Syndrome; D014458:Ulna Fractures / Q000150:complications / Q000601:surgery