Leucocyte depletion in a drowning victim during rewarming with extracorporeal circulation may limit pulmonary oedema.
BACKGROUND
We report two drowning victims with hypothermic circulatory arrest who were resuscitated with the use of extracorporeal circulation (ECC). The first patient developed severe post-bypass pulmonary oedema and inspired us to use a leucocyte-depletion filter in the second patient to attenuate leucocyte-mediated pulmonary reperfusion injury.


METHODS
In the first patient, a standard extracorporeal circuit was used. In the second patient, systemic leucocyte depletion was applied using leucocyte-depletion filters (Pall RS 1, Pall, Portsmouth, UK), in the venous side of the extracorporeal circuit. Circulating leucocyte counts were measured and arterial blood gas analysis and chest X-rays were performed.


RESULTS
Both patients showed a decrease of the circulating leucocyte counts during rewarming and had nearly similar leucocyte counts on arrival at the intensive care unit (ICU). The first patient developed severe pulmonary oedema, with poor arterial blood gases, whereas the second patient, who had leucocyte-depletion by filtration, did not develop severe pulmonary oedema, and had good arterial blood gases.


CONCLUSIONS
Profound leucocyte-depletion by means of filtration may have contributed to limit leucocyte-mediated pulmonary reperfusion injury.
Vermeijden
Wytze J
WJ
Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, The Netherlands. j.w.vermeijden@anest.umcg.nl
de Vries
Hans
H
Kieboom
Joke
J
Waterbolk
Tjalling
T
D000063:Accidents, Traffic; D000138:Acidosis / Q000188:drug therapy; D000328:Adult; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002675:Child, Preschool; D004298:Dopamine / Q000627:therapeutic use; D005112:Extracorporeal Circulation; D017809:Fatal Outcome; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D007035:Hypothermia / Q000209:etiology / Q000628:therapy; D047589:Leukocyte Reduction Procedures; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D015701:Near Drowning / Q000628:therapy; D016133:Polymerase Chain Reaction; D011654:Pulmonary Edema / Q000209:etiology / Q000517:prevention & control*; D015427:Reperfusion Injury / Q000209:etiology*; D017694:Rewarming / Q000379:methods*; D017693:Sodium Bicarbonate / Q000627:therapeutic use
D002316:Cardiotonic Agents; D017693:Sodium Bicarbonate; D004298:Dopamine