Promising method for management of venoarterial extracorporeal membrane oxygenation: A case of severe heart failure successfully stabilized by “high-flow/vasodilation method”

Toru Kondo, Akinori Sawamura, Takahiro Okumura, Naoaki Kano, Ryota Morimoto, Naoki Watanabe, Hiroaki Hiraiwa, Tasuku Kuwayama, Yuki Sugiura, Tomoaki Haga, Shogo Yamaguchi, Kenji Fukaya, Tsuyoshi Yokoi, Kazuro Fujimoto, Masato Mutsuga, Tomo Yoshizumi, Naoyuki Matsuda, Akihiko Usui, Toyoaki Murohara

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

We report the case of a 58-year-old man with dilated cardiomyopathy who was hospitalized because of worsening heart failure. As his symptoms were refractory even with the administration of inotropes, he was given peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) upon transfer to our hospital. On admission, serum creatinine was 2.62 mg/dL and total bilirubin 10.8 mg/dL. The cannulas inserted were 16-Fr for infusion and 21-Fr for drainage. When the blood flow was increased to 2.14 L/min/m2 to improve organ dysfunction, the aortic valve became continuously close with the mean arterial pressure of 85 mmHg. Therefore, we administrated vasodilators to decrease mean arterial pressure, or left ventricular afterload, which achieved opening aortic valve continuously. After the cannula sizes were scaled up to 18Fr for infusion and 24Fr for drainage to gain further blood flow, the aortic valve opened continuously and mean pulmonary pressure decreased. Our strategy to maintain adequate flow rate of VA-ECMO using vasodilator, “high-flow/vasodilation method” achieved hemodynamic stability. Additionally, the concentration of serum creatinine and total bilirubin gradually decreased to within the normal range, although the patient succumbed 58 days after transfer to our hospital. <Learning objective: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is often used as a first-line mechanical circulatory support in patients with severe heart failure. However, its management is difficult and not established. We discuss the efficacy and potency of our “high-flow/vasodilation method” in the management of VA-ECMO.>

Original languageEnglish
Pages (from-to)81-84
Number of pages4
JournalJournal of Cardiology Cases
Volume18
Issue number2
DOIs
Publication statusPublished - 08-2018
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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