title: Extracorporeal membrane oxygenation for diffuse alveolar hemorrhage and severe hypoxemic respiratory failure from silicone embolism.
abstract: Liquid silicone is an inert material that may be used for cosmetic procedures by physicians as well as illegally by non-medical personnel. The use of silicone may result in severe complications, disfigurement, and even death. In addition, the indications for extracorporeal membrane oxygenation (ECMO) support have been increasing as a salvage therapy for a variety of life-threatening conditions. The patient is a 27-year-old woman with no significant medical conditions who developed silicone emboli, and subsequent diffuse alveolar hemorrhage after being injected with silicone in her gluteal region without medical supervision. She became profoundly hypoxemic and suffered a brief asystolic cardiac arrest in this setting. The patient was placed on veno-venous ECMO support for 14 days. Medical care during ECMO was complicated by pulmonary hemorrhage, hemothorax, pneumothorax, and blood clot, resulting in oxygenator change-out. A modified adult ECMO circuit (Jostra QuadroxD, Maquet Cardiopulmonary, Rastatt, Germany) was used to transport the patient from a nearby community affiliate hospital and then reconfigured for the medical intensive care unit on a standard HL-20 heart-lung console. Although the use of ECMO for severe hypoxemic respiratory failure has been widely reported, to our knowledge, this is the first reported successful use of ECMO for silicone embolism syndrome associated with diffuse alveolar hemorrhage and severe hypoxemic respiratory failure.
authors.affiliation: Department of Clinical Perfusion, Columbia University Medical Center, New York, NY, USA. mongero@nyp.org
authors.forename: L B
authors.initials: LB
authors.lastname: Mongero
authors.forename: D
authors.initials: D
authors.lastname: Brodie
authors.forename: J
authors.initials: J
authors.lastname: Cunningham
authors.forename: C
authors.initials: C
authors.lastname: Ventetuolo
authors.forename: H
authors.initials: H
authors.lastname: Kim
authors.forename: E
authors.initials: E
authors.lastname: Sylvan
authors.forename: M D
authors.initials: MD
authors.lastname: Bacchetta
mesh_terms: D000328:Adult; D004617:Embolism / Q000209:etiology / Q000628:therapy*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy*; D020034:Silicone Gels / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D020034:Silicone Gels