International Journal of Anesthesiology & Pain Medicine

Obstructive Ventilator Injury at the End of Cardio-pulmonary Bypass, Treated with Extracorporeal Membrane Oxygenation

Although lung injury is common complication of Cardio- Pulmonary-Bypass (CPB), obstructive lung injury is a rare and possibly catastrophic complication reported to result from acute bronchospasm and non-cardiogenic pulmonary edema. Some previous reports have described acute bronchospasm at the end of CPB [1,2] in most such cases, bronchodilator treatments were effective, and patients could soon be weaned from CPB [1,2]. Accordingly, continued CPB until bronchial dilation became effective was the recommended protocol. However, we describe herein a case in which treatments for acute bronchospasm were not sufficiently effective to wean the patient from CPB even after a 1 hour period. This patient’s lungs could not be deflated at the end of CPB, a condition that was refractory to treatment and could not be managed with standard ventilation. The patient was accordingly switched from CPB to Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) to maintain valid oxygenation and improve hemostasis. The respiratory function improved gradually after aggressive treatment for pulmonary edema, and ECMO was successfully terminated. Hemostasis was also achieved with aggressive transfusion after ECMO termination.

Author(s):

Yasuhisa Okamoto

 

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