Abstract
Here we report a case of a 40-year-old man who visited the emergency room with severe chest pain. He showed a Stanford type B aortic dissection on chest-computed tomography. Despite medical treatment and malperfusion of lower extremities, acute renal failure developed; hence thoracic endovascular aortic repair (TEVAR) was considered under general anaesthesia. After endotracheal intubation, ventilation with low tidal volume required high inspiratory airway pressure. An arterial blood gas analysis showed PaCO2 of 61.8mmHg and PaO2 of 26.4mmHg, indicating a status asthmaticus of hypoxaemia and hypercarbia, which did not respond to bronchodilator or mechanical ventilation. Impending cardiac arrest was treated using venovenous extracorporeal life support, which was administered by percutaneous femoral cannulation. Surgical procedure was completed without any complications. Extracorporeal life support was weaned at one day after the operation. The patient was discharged without any complications.
Highlights
Status asthmaticus, a reversible respiratory failure, does not respond to conventional bronchodilator
A 40-year-old male (140kg, 165cm) patient was transferred to our emergency room with chest pain
After VV ECLS, hypoxemia and hypercarbia were improved on arterial blood gas analysis
Summary
A 40-year-old male (140kg, 165cm) patient was transferred to our emergency room with chest pain. He had hypertension, coronary artery disease, and bronchial asthma that were not treated. Coronary artery disease, and bronchial asthma that were not treated He visited the pulmonology department with exertional dyspnea one year before surgery. He had mild obstructive airway disease and allergen skin prick test revealed bronchial asthma to specific allergen. On chest X-ray, there was no abnormal finding (Figure 1). Contrast-enhanced computed tomography scan revealed Stanford type B aortic dissection from descending thoracic aorta to iliac arteries (Figure 2). Before transferring him to the operating room, 0.2mg glycopyrrolate was injected intramuscularly.
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