A case report of thrombotic complete obstruction of the ascending aorta as a complication of Venoarterial extracorporeal membrane oxygenation support: steps to prevent thrombosis
A case report of thrombotic complete obstruction of the ascending aorta as a complication of Venoarterial extracorporeal membrane oxygenation support: steps to prevent thrombosis
复制标题
DOI：
10.1186/s13019-020-01239-3
复制
发表时间：
2020-07-23
影响因子：
1.6
通讯作者：
Yorozuya, Toshihiro
中科院分区：
文献类型：
--
作者：
Nishihara, Tasuku;Kudamatsu, Natsuko;Yorozuya, Toshihiro
研究背景静脉动脉体外膜肺氧合（VA-ECMO）是急诊和重症医学领域的重要设备。然而，长期使用VA-ECMO会出现各种严重并发症，包括血栓形成。病例介绍一名60岁男子因感染性心内膜炎接受了第三次同种主动脉根置换术。虽然手术是困难的，因为严重的粘连所造成的前两个干预措施，主动脉根部置换术使用同种异体移植物。在从体外循环中撤出时，由于手术部位出血，难以维持血流动力学，导致低血容量性休克。随后心功能恶化;因此，建立VA-ECMO并完成手术。三天后，血栓在同种移植物内形成并完全闭塞升主动脉。进行了血肿清除，但心功能未改善。最终，患者发生脑梗死死亡。为了防止术后VA-ECMO管理下非常严重的低心排血量病例中的血栓形成，必须防止VA-ECMO的血流停滞，因为抗凝治疗将是困难的。近年来广泛应用的Impella心室辅助装置可产生前向血流，有效地防止了血栓的形成。结论为防止极严重低心排情况下的血栓形成，应在建立VA-ECMO时就联合引入Impella（R），以防止血栓形成。
BackgroundVenoarterial extracorporeal membrane oxygenation (VA-ECMO) is an essential device in the field of emergency and intensive-care medicine. However, long-term use of VA-ECMO has various severe complications, including thrombosis.Case presentationA 60-year-old man underwent his third aortic root replacement using a homograft because of infectious endocarditis. Although the operation was difficult because of severe adhesion caused by the two previous interventions, aortic root replacement using a homograft was performed. At the time of withdrawal from cardiopulmonary bypass, the maintenance of hemodynamics was difficult because of bleeding from the surgical site, leading to hypovolemic shock. Cardiac function subsequently deteriorated; therefore, VA-ECMO was established and the operation was finished. Three days later, thrombus was formed inside the homograft and completely occluded ascending aorta. Evacuation of hematoma was performed, however, cardiac function was not ameliorated. Eventually, the patient had brain infarction and died. To prevent thrombus formation in very severe low cardiac output cases under VA-ECMO management after surgery, to prevent the stagnation of the blood flow from VA-ECMO will be necessary because anticoagulant therapy will be difficult. Impella ventricular assist device which is recently used widely generates anterograde blood flow and effectively prevents stagnation.ConclusionsTo prevent thrombus formation in cases of very severe low cardiac output, Impella (R) should be combinatorially introduced from the beginning of VA-ECMO establishment to prevent thrombosis.