Extracorporeal Oxygenation Support Research Articles

Fulminant Giant Cell Myocarditis following Heterologous Vaccination of ChAdOx1 nCoV-19 and Pfizer-BioNTech COVID-19

A 48-year-old female patient underwent a heart transplantation for acute fulminant myocarditis, following heterologous vaccination with the ChAdOx1 nCoV-19 and Pfizer-BioNTech COVID-19. She had no history of severe acute respiratory syndrome coronavirus-2 infection. She did not exhibit clinical signs or have laboratory findings of concomitant infection before or after vaccination. Heart transplantation was performed because her heart failed to recover with venoarterial extracorporeal oxygenation support. Organ autopsy revealed giant cell myocarditis, possibly related to the vaccines. Clinicians may have to consider the possibility of the development of giant cell myocarditis, especially in patients with rapidly deteriorating cardiac function and myocarditis symptoms after COVID-19 vaccination.

Extracorporeal oxygenation support for curative surgery in a patient with papillary thyroid carcinoma invading the trachea

Local extension of thyroid carcinoma can result in massive invasion of the trachea, causing severe airway compromise. The pre- and peri-operative management of such airway compromise is difficult but critical. We report the use of extracorporeal oxygenation support as an alternative peri-operative airway management option in such a situation. This approach facilitated curative surgery in a patient with papillary thyroid carcinoma invading the trachea. We present a case report regarding extracorporeal oxygenation support in a patient with locally advanced thyroid carcinoma. The patient was a 68-year-old woman with aggressive thyroid papillary carcinoma invading the trachea. The airway was almost totally obstructed, and tracheal resection and end-to-end anastomosis was planned. A venovenous bypass catheter was placed for cardiopulmonary bypass, using the bilateral femoral veins. Curative surgery and reconstruction were then performed successfully, under general anaesthesia assisted by cardiopulmonary bypass oxygenation. Cardiopulmonary bypass oxygenation is a safe and effective alternative airway management option in patients with locally aggressive thyroid cancer.

Cannulation of the proximal aorta during long-term membrane lung perfusion

Prolonged extracorporeal oxygenator support for acute respiratory failure is a clinical reality. Recent experience with 4 patients has demonstrated an advantage in delivery of saturated blood to the root of the aorta during venoarterial (VA) bypass. We have been able to perfuse the heart and bilateral cerebral hemispheres by advancing the tip of a large perfusion cannula to the aortic root from the common femoral artery. When the catheter did not pass beyond the transverse aortic arch, there was marked asymmetry of oxygenator perfusion, as determined by differential oxygen tension in right and left radial artery blood and by xenon-133 scans following isotope injection into the arterial return line. Long-term VA bypass lasting from 5 to 11 days resulted in long-term survival in 2 patients with post-traumatic gram-negative pneumonitis. The other patients, who had viral pneumonitis and post-transfusion respiratory failure, died after 9 and 11 days of membrane oxygenator support. No embolic lesions or arterial or valvular injuries were discovered at autopsy. This is a safe and useful method of providing oxygenated blood to the aortic root for equal distribution to the rest of the body.

Extracorporeal Oxygenation: A Flower Before the Spring?

Progressive hypoxemia in acute respiratory failure is the most critical threat to the survival of the patient. While hypercapnia of severe degree can be tolerated in the presence of adequate arterial oxygen tensions, and hydrogen ion imbalance can be compensated in various ways, there is no available method by which the function of vital organs can be preserved without an adequate oxygen supply for their metabolic needs. When this cannot be achieved by the use of 100 percent oxygen and a volume-limited ventilator with positive end expiratory pressure incorporated in the circuit, the usual recourse is to employ adjuvant therapy including adrenal corticosteroid and diuretic drugs and anticoagulants when appropriate. If these desperate measures fail, the outlook for the patient is gloomy indeed. Reduced effective compliance confirms the presence of a stiff lung, which is increasingly difficult to ventilate, and the elevated airway pressures generated and high oxygen concentrations administered are likely to further damage an already severely diseased respiratory system. Against this uncomfortably familiar background, the use of extracorporeal oxygenator support has emerged and increasing attention is being directed to its use. The paper by Lefrak and his colleagues in this issue (page 385) brings focus to bear on some of the problems involved in this technique.

Arterial oxygenation. Mechanisms for improvement during partial cardiopulmonary support.

THIS case is presented to illustrate the possible roles of factors that relieve arterial hypoxemia during partial venous-arterial extracorporeal oxygenator support (ECOS).1 Report of a Case The patient was a 50-year-old man with a one-year history of rheumatic heart disease. Medical management had been virtually absent because of his refusal to consult a physician regularly. He was admitted to the emergency ward with refractory pulmonary edema and immediately suffered a cardiac arrest. Resuscitation was difficult, requiring nearly three hours, with repeated episodes of cardiac arrest. Cardiac catheterization was not thought advisable because of his critical condition. Six hours after admission, while he was still hypotensive and in coma, replacement of the aortic and mitral valves was performed. After surgery, reexploration was required twice because of bleeding. He was treated with increasing amounts of isoproterenol and dopamine hydrochloride, but remained anuric and hypotensive. Because of rapid atrial fibrillation, counterpulsation by