Catastrophic left heart distension following initiation of venoarterial extracorporeal membrane oxygenation in a patient with mild aortic regurgitation.

摘要

Despite intra-aortic balloon counterpulsation and infusions of adrenaline (0.05 to 0.15 mug/kg/ minute) and dopamine (5 mug/kg/minute), his shock state worsened and intubation and ventilation followed by VA, ECMG were planned. On induction of anaesthesia the patient suffered a cardiac arrest. VA ECMO was initiated during cardiopulmonary resuscitation. ECMO cannulation consisted of a 24 Fr cannula placed in a femoral vein, a 19 Fr cannula placed in the contralateral femoral artery, and a 10 Fr distal perfusion cannula placed in the same femoral artery. Cannulae were placed percutaneously, guided by surface ultrasound and transoesophageal echocardiography. Following anticoagulation with unfractionated heparin, VA ECMO was initiated at a flow of 5 1/minute.