title: ECMO for intractable status asthmaticus following atracurium.
abstract: Intraoperative allergic reactions are rare but serious events associated with increased morbidity and mortality. We report the salvage of intraoperative anaphylaxis leading to extreme hypercapnic respiratory failure by veno-venous extracorporeal membrane oxygenation (ECMO). A 38-year-old woman undergoing thyroidectomy developed intractable bronchospasm after administration of atracurium, leading to extreme hypercapnic respiratory failure (PaCO2> 250 mmHg, pH 6.773). After the failure of conventional medical therapy and ventilatory optimization, the patient was connected to a veno-venous ECMO circuit. PaCO2of 45.6 mmHg and pH of 7.25 were achieved in 1 h, by slowly increasing sweep gas flows up to 3.5 L/min and using continuous end-tidal CO2monitoring to gauge the procedure. After extubation and disconnection from ECMO, the patient was discharged on the 6th day without sequelae. Rapid reversal of extreme hypercapnic acidosis by ECMO was feasible, without any neurologic sequelae. Veno-venous ECMO support may be a valuable option for the salvage of intraoperative anaphylaxis.
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, MI, Italy. vittorio.scaravilli@gmail.com.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Scaravilli
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, MI, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Grasselli
authors.affiliation: Dipartimento di Anestesia e Terapia Intensiva, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Benini
authors.affiliation: Dipartimento di Anestesia e Terapia Intensiva, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Bombino
authors.affiliation: Scuola di Medicina e Chirurgia, Università Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Ceriani
authors.affiliation: Dipartimento di Anestesia e Terapia Intensiva, Ospedale San Biagio, Piazza Vittime dei Lager Nazifascisti 1, 28845, Domodossola, VB, Italy.
authors.forename: Uta
authors.initials: U
authors.lastname: Emmig
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, MI, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanella
authors.affiliation: Dipartimento di Anestesia e Terapia Intensiva, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy.|Scuola di Medicina e Chirurgia, Università Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Patroniti
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, MI, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
mesh_terms: D000328:Adult; D001279:Atracurium / Q000009:adverse effects*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000628:therapy*; D013224:Status Asthmaticus / Q000139:chemically induced* / Q000628:therapy*
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium
keywords: Anaphylaxis; Bronchial spasm; Extracorporeal membrane oxygenation; Hypercapnia; Respiratory insufficiency