title: Efficacy of "Awake ECMO" for critical respiratory failure after pediatric open-heart surgery.
abstract: A 4-year-old boy with atrioventricular discordance, double-outlet right ventricle, pulmonary stenosis, and mitral regurgitation, was undergoing anatomical repair consisting of Senning, Rastelli, Damus-Kaye-Stansel procedures, and a mitral valve repair, complained of post-operative excessive airway tract secretion, which ultimately developed into acute respiratory distress syndrome (ARDS) 28 days after the operation. The cause of the ARDS was thought to be frequent manual positive pressure recruitment and prolonged inhalation of pure oxygen. At 45 days after the operation, hypercapnia and respiratory acidosis turned out to be irreversible, and therefore, veno-arterial extracorporeal membrane oxygenation (ECMO) was established utilizing the Endumo(®)4000 system. Pulmonic interstitial inflammation gradually improved while resting the lung under ECMO support; however, effective ventilation volume decreased critically because a massive pulmonary hemorrhage occurred at 2 and 9 days after the initiation of ECMO. To maximize the effectiveness of respiratory physical therapy, "Awake ECMO" was started and tidal volume dramatically increased with a regained cough reflex. Five days later, he was successfully weaned off from ECMO, and discharged 7 months after the operation without any neurological and physiological sequelae.
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Higashida
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan. thoashi@surg1.med.osaka-u.ac.jp.
authors.forename: Takaya
authors.initials: T
authors.lastname: Hoashi
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kagisaki
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Shimada
authors.affiliation: Department of Clinical Engineering, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Clinical Engineering, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan. ichikawa@hsp.ncvc.go.jp.
authors.forename: Hajime
authors.initials: H
authors.lastname: Ichikawa
mesh_terms: D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D004310:Double Outlet Right Ventricle / Q000601:surgery; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012131:Respiratory Insufficiency; D013990:Tidal Volume
keywords: Endumo; Extracorporeal membrane oxygenation; Pediatric