Ulus Travma Acil Cerrahi Derg. 2018; 24(5): 497-500 | DOI: 10.5505/tjtes.2018.33802

Travmaya baðlý ciddi akciðer kontüzyonu ve hipovolemik þoku olan bir hastaya heparin verilmeden uygulanan veno-venöz ECMO

Seong Ho Moon¹, Ki Nyun Kim¹, Jae Jun Jung¹, Jae Hong Park², Joung Hun Byun^1
1Gangwongsang Ulusal Üniversitesi Týp Fakültesi, Göðüs ve Kalp Damar Cerrahisi Bölümü, Changwon Hastanesi, Changwon, Güney Kore
²Sungkyunkwan Üniversitesi Týp Fakültesi, Göðüs ve Kalp-Damar Cerrahisi Bölümü, Samsung Changwon Hastanesi, Gyeongsangnam-do, Güney Kore

Akciðer aþýrý derecede hasarlandýðýnda ve konvansiyonel tedavi baþarýsýz olduðunda venovenöz ekstrakorporeal membran oksijenizasyonu (VV-ECMO) kritik rol oynar. ECMO dokunun yeterince oksijenlenmesine ve akciðerin toparlanmasýna olanak saðlar. Tedavi sýrasýnda sistemik antikoagülasyon uygulandýðýndan kanama riski olan hastalarda ECMO kontrendike olmayý sürdürmektedir. Yirmi altý yaþýnda kadýn hasta gelmeden bir saat önce trafik kazasý nedeniyle politravma geçirmiþ. Basit torasik radyografi ve bilgisayarlý tomografi sað akciðer atelektazisiyle birlikte geniþ bir sað hemopnömotoraks ve sað akciðerde ciddi kontüzyonun varlýðýný gösterdi. ECMO desteði altýnda baþarýyla sað alt lob çýkartýldý. Hemorajik þoklu politravma hastalarýnda kontrendike olmasýna raðmen kanama iyice kontrol altýna alýnmýþsa ECMO uygulamasý mümkün olabilir. Hasta önemli bir komplikasyon olmaksýzýn taburcu edilmiþtir.

Anahtar Kelimeler: Ekstrakorporeal membran oksijenizasyonu, hemorajik þok; politravmatik.

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Heparin-free veno-venous ECMO applied to a patient with severe lung contusion and hypovolemic shock due to trauma

Seong Ho Moon¹, Ki Nyun Kim¹, Jae Jun Jung¹, Jae Hong Park², Joung Hun Byun^1
1Department of Thoracic and Cardiovascular Surgery, Changwon Hospital, Gyeongsang National University College of Medicine, Republic of Korea, Changwon - South Korea
²Department of Thoracic and Cardiovascular Surgery, Samsung Changwon Hospital, Sungkyunkwan University College of Medicine, Gyeongsangnam-do - Korea

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) plays a crucial role when the lung is extensively damaged and when conventional management has failed. ECMO provides adequate tissue oxygenation and an opportunity for lung recovery. However, ECMO remains contraindicated in patients with a risk of bleeding because of systemic anticoagulation during the treatment. A 26-year-old female experienced polytrauma due to a traffic accident 1 h before arrival. Simple chest radiography and chest computed tomography showed a large right hemopneumothorax with atelectasis of the right lung and severe contusion of the left lung. Heparin-free VV-ECMO was applied peripherally via both femoral veins. Under the ECMO support, right lower lobectomy was successfully performed. Although contraindicated in polytraumatic patients with hemorrhagic shock, surgical repair with the application of ECMO may be feasible if bleeding is well controlled. The patient was discharged without significant complications.

Keywords: Extracorporeal membrane oxygenation, hemorrhagic shock, polytraumatic.

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