Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Application of Veno-venoarterial Extracorporeal Membrane Oxygenation in Multitrauma Patient with ARDS - A case report -

다발성 외상으로 유발된 급성호흡부전증후군 환자에서 정맥-정맥동맥 체외막 산화기(ECMO)의 적용 - 1예 보고 -

  • Lee, Sung Jun (Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital) ;
  • Chee, Hyun Keun (Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital) ;
  • Hwang, Jae Joon (Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital) ;
  • Kim, Jun Seok (Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital) ;
  • Lee, Song Am (Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital) ;
  • Kim, Jin Sik (Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital)
  • 이성준 (건국대학교병원 흉부외과) ;
  • 지현근 (건국대학교병원 흉부외과) ;
  • 황재준 (건국대학교병원 흉부외과) ;
  • 김준석 (건국대학교병원 흉부외과) ;
  • 이송암 (건국대학교병원 흉부외과) ;
  • 김진식 (건국대학교병원 흉부외과)
  • Received : 2009.08.25
  • Accepted : 2009.10.20
  • Published : 2010.02.05
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Abstract

Acute respiratory distress syndrome (ARDS) is difficult to treat and it is often fatal. If the medical treatment for ARDS is not effective, then extracorporeal membrane oxygenation (ECMO) can be applied to the patient. A 22-year-old female who suffered multiple traumatic injuries due to a car accident presented with acute respiratory distress syndrome. Veinarterial extracorporeal membrane oxygenation (VA ECMO) was started to treat her respiratory failure. With the VA ECMO, the systemic oxygen saturation remained at only 84%, and so the ECMO system was switched to V-VA ECMO via an additional venous outflow through the right jugular vein to increase both the systemic and pulmonary oxygen saturation. After conversion to the V-VA type ECMO, the systemic oxygen saturation increased to 94% and the partial pressure of oxygen ($PaO_2$) increased to 65 mmHg. We report here on a successful case of ECMO conversion from the VA type to the V-VA type in a patient with severely hypoxic respiratory failure.

급성호흡부전증후군은 치료가 어렵고 치명율이 높다. 인공호흡기 치료에 반응하지 않는 중증의 경우 체외막 산화기(Extracorporeal membrane oxygenation, ECMO)가 적용되고 있다. 교통사고로 다발성 외상을 받은 21세 여자가 흉부 방사선상 양측폐에 심한 침윤 소견과 동맥혈가스 검사상 급성호흡부전증후군(Acute respiratory distress syndrome, ARDS)으로 판단되어 정맥동맥 체외산화기(Veno- arterial Extracorporeal Membrane Oxygenation, VA ECMO) 치료를 시작하였다. ECMO 적용 2일째 흉부 방사선상 폐 침윤 소견 악화되면서 동맥혈 산소 포화도(Systemic oxygen saturation, $SaO_2$)가 85% 미만으로 저하되었다. 이에 중추신경계와 폐의 산소화를 향상시키기 위해 ECMO의 유출로에 곁회로를 이용하여 우측 경정맥에 연결하여 정맥-정맥동맥 ECMO (Veno-venoarterial ECMO, V-VA ECMO)로 전환하였고 이후 동맥혈 산소 분압($PaO_2$) 65 mmHg, $SaO_2$ 94%로 향상되었다. V-VA ECMO로의 전환은 전신에 산소 공급을 늘리기 위해 고려해 볼 수 있는 방법으로 생각된다.

Keywords

References

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