title: [Extracorporeal membrane oxygenation for severe acute respiratory and heart failure in a child with severe pneumonia].
abstract: OBJECTIVE
  To report clinical application of Extracorporeal membrane oxygenation for severe acute respiratory and heart failure in a child with severe pneumonia.
  
  
  METHODS
  A seven-year old male patient with severe pneumonia complicated with heart and lung function failure was admitted to PICU in 28th of December, 2008.Veno-artery access was set up via euthyphoria cannulation in operative incision. Blood was drained from the right atrium through a cannula introduced via femoral veins, and returned via femoral artery. The inter-surface of the ECMO equipment system was completely coated with heparin-coating technique. Anticoagulation was maintained with heparin to keep the activated clotting time (ACT) between 150 and 200 seconds and heparin usage dose was 10 U/(kg.h), mean blood flow was 1/2-2/3 of 80-120 ml/(kg.min) during ECMO assistant period. During ECMO, ventilator settings were gradually reduced to allow lung rest, i.e. peak inspiratory pressure less than 25 cm H2O (1 cm H2O=0.098 kPa), end expiratory pressure 8-10 cm H2O, rate 10-15 breaths per minute and FiO2 30%-40%.
  
  
  RESULTS
  In management of ECMO, the incipient blood flow was set at 0.8 L/min, the radio of oxygen and blood flow was 1:1, FiO2 60%. After ten minutes of ECMO working, the blood oxygen saturation of radial artery increased from 40 mm Hg (1 mm Hg=0.133 kPa) to 177 mm Hg, Lac decreased from 3.5 mmol/L to 2.8 mmol/L. Four hours later, blood gas analysis of radial artery showed PaO2 202 mm Hg, PCO2 44 mm Hg, Lac 1.5 mmol/L, blood flow was set at 0.6 L/min, FiO2 60%, PaO2 kept above 150 mm Hg. 96 hours after ECMO supporting, the blood flow was set at 0.4 L/min [20 ml/(kg.min)], the results of blood gas analysis of radial artery was PaO2 190 mm Hg, PaCO2 36 mm Hg, SaO2 100%, Lac 0.9 mmol/L, then the child weaned off successfully from ECMO. Two days later, the child was successfully extubated. After two weeks treatment, the patient was discharged. The main complication associated with extracorporeal membrane oxygenation were bleeding.
  
  
  CONCLUSIONS
  ECMO is an effective mechanical assistant therapy method for severe pulmonary and cardiac failure in a child.
authors.affiliation: Department of PICU, Bayi Children's Hospital Affiliated to the Military General Hospital of Beijing, the People's Liberation Army, Beijing 100700, China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Xu
authors.forename: Zhi-chun
authors.initials: ZC
authors.lastname: Feng
authors.forename: Xiao-yang
authors.initials: XY
authors.lastname: Hong
authors.forename: Song
authors.initials: S
authors.lastname: Fu
authors.forename: Geng-xu
authors.initials: GX
authors.lastname: Zhou
authors.forename: Wen-zhi
authors.initials: WZ
authors.lastname: Guo
authors.forename: Xiu
authors.initials: X
authors.lastname: Yin
mesh_terms: D002648:Child; D015199:Extracorporeal Membrane Oxygenation; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D058028:Research Report; D012120:Respiration Disorders / Q000209:etiology / Q000628:therapy*