[Interventional lung assist membrane ventilator. Successful use despite heparin-induced thrombocytopenia type II]

Pumpless extracorporeal carbon dioxide elimination using the interventional lung assist (iLA) membrane ventilator is a modern concept for the treatment of hypercapnia due to respiratory failure which cannot be sufficiently treated by conventional strategies. Heparin-induced thrombocytopenia type II (HIT II) is considered to be an absolute contraindication for placement of an iLA because of the system's heparin-coated diffusion membrane. The example demonstrates that iLA therapy can be continued despite occurrence of a HIT II in terms of an "off label use". In the case described, postoperative therapy using the iLA membrane ventilator was installed in a 69-year-old patient with severe ARDS after elective lung resection. Despite a confirmed HIT II detected in the course of iLA, this therapy was continued after changing systemic anticoagulation to argatroban. The platelet count increased again and the patient could be successfully weaned from the iLA membrane and finally transferred to a rehabilitation centre.