| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1998;66:1467-1468
© 1998 The Society of Thoracic Surgeons
a Second Department of Surgery, Intensive Care Unit, and Pediatric Surgery Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520 Japan
To the Editor
We read with great interest the article by Trittenwein and associates [1] on the use of preoperative extracorporeal membrane oxygenation (ECMO) for congenital cyanotic heart disease. We also used ECMO for a neonate with cyanotic heart disease, with a double-lumen cannula before and during central shunt operation. We present here our experience with preoperative ECMO for a cyanotic patient and discuss the usefulness of a venous double-lumen cannula for blood access in ECMO.
The patient was a boy born at full term with a birth weight of 2,200 g. A heart murmur was detected on the first day of life. He was diagnosed with Pierre-Robin syndrome and meningocele, and underwent repair of meningocele on his third day of life. At that time, echocardiographic examination revealed tetralogy of Fallot with a patent ductus arteriosus. On the ninth day after birth, cyanosis increased and percutaneous arterial oxygen saturation decreased to 60%. Despite the administration of prostaglandin E1 and use of mechanical ventilation, cyanosis did not improve and the percutaneous arterial oxygen saturation decreased to 50%. Repeated echocardiographic examination did not detect patent ductus arteriosus flow, and both pulmonary valvular and infundibular stenoses were severe. Myorelaxant drugs and nitric oxide were given, and the percutaneous arterial oxygen saturation recovered to 70%. Under this treatment, nutritional management was also begun to increase body weight, because he appeared to be too small to undergo a palliative or definitive operation. However, the 16th day after birth, arterial oxygen saturation suddenly decreased to 40%, and metabolic acidosis progressed in arterial blood samples (pH 7.0) taken from the radial artery.
We decided to use ECMO on the assumption that central shunt placement would be performed. A 12F double-lumen catheter (Cook Inc, Bloomington, IN) was percutaneously inserted into the right internal jugular vein and ECMO was instituted. The ECMO circuit was primed with homologous blood with 2 IU/mL of heparin sodium. Heparin was then infused to maintain a 150-second activated coagulation time. Silox-S (Mera, Tokyo, Japan) was used as a membrane oxygenator, an MSH-51 (Mera) was used as a heat exchanger, and a Twin Pump Module (Jostra Japan, Tokyo, Japan) was used as a pump. Actual flow ranged from 100 to 130 mL/min.
After initiation of ECMO, arterial oxygen saturation immediately increased to 90%. After 13 hours of ECMO, his general condition was stabilized, and a central shunt operation was safely performed under ECMO. Extracorporeal membrane oxygenation was easily weaned after the operation, but 3 hours postoperatively continuous hemodialysis (CHDF) was required to treat anuria caused by heart failure associated with shunt operation. The CHDF was performed through the same access using the double-lumen cannula.
The CHDF system was used for CHF-1 (Ube Junken, Osaka, Japan), with the APF-01D (Asahi Medical Co, Ltd, Tokyo, Japan) hemofilter membrane, Sublood-B dialysate (Fuso Yakuhin Co, Osaka, Japan). The flow rate was maintained at 20 mL/min, and the activated coagulation time was adjusted to about 150 seconds with administration of nafamostat mesilate. After 3 hours of CHDF, urination began, and he could be weaned from CHDF 2 days after the operation. Respiratory status also improved, and the tracheal tube was extubated 4 days after the operation. However, the third day after extubation, aspiration pneumonia suddenly developed and mechanical ventilator management was begun again, but the patient died of multiple organ failure followed by pulmonary infection at 28 days after shunt placement.
Recently, artificial assistant systems for respiratory or renal function have improved and techniques have enabled their use for neonates [2, 3]. Unfortunately, we have not used the AREC (assistence respiratoire extra-corporelle) system [2, 4] and cannot compare the efficacies of the two types of cannula. However, our method of ECMO with a venous double-lumen cannula appeared to have less effect on neonatal circulation, especially in patients with congenital heart disease, than ECMO with a single-lumen cannula. Furthermore, the cannula could be changed to use for CHDF when necessary.
References
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
