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Prolonged total extracorporeal lung assistance without systemic heparinization
O Fjalldal1, B Torfason, P T Onundarson
1Department of Anesthesia and Intensive Care, Landspitalinn National University Hospital, Reykjavik, Iceland.
Acta Anaesthesiologica Scandinavica
|January 1, 1993
Summary
Extracorporeal lung assist (ECLA) saved a patient with severe ARDS in a single lung. A heparin-coated circuit prevented clotting without systemic anticoagulation, enabling lung recovery.
Area of Science:
- Cardiology
- Pulmonology
- Critical Care Medicine
Background:
- Severe acute respiratory distress syndrome (ARDS) in a single lung poses significant management challenges.
- Pneumonectomy for trauma necessitates advanced respiratory support strategies.
Observation:
- A 16-year-old female with ARDS in her remaining lung after pneumonectomy required intensive support.
- A novel approach utilizing total extracorporeal lung assist (ECLA) was implemented.
Findings:
- A covalently heparin-coated ECLA circuit for 40 days proved lifesaving, obviating the need for systemic heparinization.
- The ECLA system achieved extracorporeal blood flow (ECBF) near cardiac output (CO), fully replacing lung function.
- Despite systemic primary fibrinolysis, no major bleeding complications occurred.
Implications:
- This case highlights the potential of heparin-coated ECLA as a safe and effective bridge to lung recovery in complex ARDS.
- Advanced cannulation techniques and patient positioning can optimize extracorporeal circulation.
- Successful ECLA management facilitated eventual lung recovery and patient discharge.