Application of veno-arterial-venous extracorporeal membrane oxygenation in differential hypoxia.
Veno-arterial extracorporeal membrane oxygenation (ECMO) through the femoral vein and artery may cause differential hypoxia, i.e., lower PaO2 in the upper body than in the lower body, because of normal cardiac output with severe impairment of pulmonary function. Hereby, we report the diagnosis and the treatment of differential hypoxia caused by veno-arterial ECMO. A 39-year-old man received cardiopulmonary resuscitation from a cardiac arrest due to acute myocardial infarction. Even after more than 30 min of resuscitation, spontaneous circulation had not resumed. Next, we performed veno-arterial ECMO through the femoral artery and vein, and the patient recovered consciousness on the second day of ECMO. On day 5 of ECMO, he lost consciousness again and presented a generalized tonic-clonic seizure, and an electroencephalogram showed delta waves suggesting diffuse cerebral cortical dysfunction. While an echocardiogram revealed improvements in myocardial function, a follow up chest radiograph showed increasing massive parenchymal infiltrations, and gas analysis of blood from the right radial artery revealed severe hypoxemia. These findings indicated a definite diagnosis of differential hypoxia, and therefore, we inserted a 17-Fr cannula into the left subclavian vein as a return cannula. The patient's consciousness and pulmonary infiltrations were improved 2 days after veno-arterial-venous ECMO, and the electroencephalogram showed normal findings. To our knowledge, this is the first report of successful clinical management of differential hypoxia. We suggest that veno-arterial-venous ECMO could be the treatment of choice for differential hypoxia resulting from veno-arterial ECMO.
Deparment of Cardiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
Joon Hyouk
JH
Choi
Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Aran 13 gil 15, Jeju-si, Jeju Special Self-Governing Province 690-767 Korea.
Su Wan
SW
Kim
Deparment of Cardiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
Young Uck
YU
Kim
Deparment of Cardiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
Song-Yi
SY
Kim
Deparment of Cardiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
Ki-Seok
KS
Kim
Deparment of Cardiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
Seung-Jae
SJ
Joo
Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
Jung Seok
JS
Lee
Brain; Extracorporeal membrane oxygenation; Lungs; Pulmonary function