title: [Extracorporeal Membrane Oxygenation for Anesthesia Induction in a Patient with Severe Cardiorespiratory Impairment due to Mediastinal Angiosarcoma].
abstract: BACKGROUND
  Mediastinal angiosarcoma is a rare intrathoracic tumor that can cause severe pleural and pericardial fibrosis.
  
  
  METHODS
  We report the anesthetic management for pericardiectomy and pleurolysis in a 33-year-old patient with a mediastinal angiosarcoma. He presented with severe restrictive ventilatory impairment and heart failure due to fibrosis of the pleura and pericardium. Spirometry indicated a forced vital capacity of 0.66 l, while arterial blood gas analysis under noninvasive positive pressure ventilation indicated hypercapnia (pH 7.44; Pa(CO2) 59.2 mmHg). His cardiac index was 1.36 l x min(-1) x m(-2). Anesthesia induction and positive pressure ventilation are associated with an extremely high cardiorespiratory risk; therefore, veno-arterial-extracorporeal membrane oxygenation (VA-ECMO) with femoral cannulation was started prior to anesthesia induction. After achieving a stable circulation and adequate gas exchange, anesthesia was induced, and mechanical ventilation with intratracheal intubation was initiated. With ECMO and inotropic support stable hemodynamics was maintained throughout anesthesia induction and the operation was performed uneventfully under cardiopulmonary bypass. The patient was extubated on the first postoperative day and discharged one month after the operation.
  
  
  CONCLUSIONS
  ECMO is a useful option to secure adequate gas exchange and circulation during anesthesia induction in patients with severe cardiopulmonary problems due to mediastinal tumors.
authors.forename: Shino
authors.initials: S
authors.lastname: Matsukawa
authors.forename: Hiroki
authors.initials: H
authors.lastname: Daijo
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Mizota
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D006333:Heart Failure / Q000209:etiology; D006338:Heart Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006394:Hemangiosarcoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D011859:Radiography; D012128:Respiratory Distress Syndrome; D019616:Thoracic Surgical Procedures