Extracorporeal Membrane Oxygenation for Adult Respiratory Distress Syndrome after Near-drowning

Andreas Pikwer

doi:10.4172/2167-0870.1000172

Abstract

Background: Near-drowning victims surviving the initial period of asphyxia may develop life-threatening adult respiratory distress syndrome (ARDS). We highlight current understanding of extracorporeal membrane oxygenation (ECMO) for successful clinical management of severe ARDS in adult near-drowning victims with reference to a recent case of accidental submersion. Patient: Previously healthy 18-year-old female near-drowning victim with progressive hypoxaemia, hypercapnaemia, acidaemia and multiple organ failure. Results: Rapid restitution of respiratory function during a three-day period of treatment with venovenous ECMO. Conclusion: Extracorporeal membrane oxygenation is a feasible option in near-drowning adult victims with progressive ARDS not responding appropriately to conventional protective ventilation.

Highlights

A near-drowning victim surviving the initial period of prolonged asphyxia may develop life-threatening Adult Respiratory Distress Syndrome (ARDS)
Within the 48 hours she deteriorated with pneumomediastinum, pneumoperitoneum, hypoxaemia, hypercapnaemia, and adult respiratory distress syndrome (ARDS), as part of multiple organ failure including leucopenia, progressive coagulopathy, and systemic hypotension. She was transferred to the national extracorporeal membrane oxygenation (ECMO) centre in Stockholm within the twelve hours
The patient gradually stabilized during the 73-hour period of venovenous ECMO treatment, was referred back to her hospital and recovered with no major neurological deficit

Summary

Introduction

A near-drowning victim surviving the initial period of prolonged asphyxia may develop life-threatening Adult Respiratory Distress Syndrome (ARDS). Some centres recommend Extracorporeal Membrane Oxygenation (ECMO) in selected near-drowning paediatric patients [1,2,3,4,5], whereas few adult cases have been reported [6]. We highlight current understanding of this option of treatment in adult near-drowning victims with reference to a recent case, where ECMO was successfully used to treat an adult female near-drowning victim with severe ARDS. She was initially extubated and transferred to the intensive care unit.

Results

Conclusion