Issue |
J Extra Corpor Technol
Volume 42, Number 3, September 2010
|
|
---|---|---|
Page(s) | 238 - 241 | |
DOI | https://doi.org/10.1051/ject/201042238 | |
Published online | 15 September 2010 |
Abstract
Minimizing Reperfusion Injuries: Successful Resuscitation Using eCPR After Cardiac Arrest on a Post-Operative Norwood Patient
Address correspondence to: Keith Amberman, CCP, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042. E-mail: keith.amberman@inova.org
Received:
10
March
2010
Accepted:
26
August
2010
In patients with hypoplastic left heart syndrome (HLHS), the left ventricle is too small to circulate adequate oxygenated blood. If left untreated, HLHS is fatal. A 3-staged palliative procedure ultimately leading to a single ventricle physiology is the preferred management strategy for HLHS in most pediatric cardiac centers in the United States. In this report, a 1-month-old infant developed cardiac arrest 3 weeks after undergoing a Norwood procedure as an initial palliation for HLHS. After 151 minutes of cardio-pulmonary resuscitation (CPR) with intermittent, but non-sustainable return of spontaneous circulation, extracorporeal cardio-pulmonary resuscitation (eCPR) was used. Utilizing the carotid artery and internal jugular vein for cannulation, we connected our extracorporeal membrane oxygenation (ECMO) circuit to the patient. To minimize reperfusion injury, immediate cooling, arterial/venous shunting, minimal calcium, and hemodilution strategies were used. Once paCO2/pvCO2 gradients were minimized, we instituted sweep gas and gradually increased fiO2 as pH normalized. The patient was successfully weaned from ECMO and discharged. eCPR was used successfully in the resuscitation of this patient and reperfusion injuries were minimized despite prolonged CPR.
Key words: extracorporeal cardiopulmonary resuscitation / reperfusion injury / hypoplastic left heart syndrome / Norwood procedure / Pediatric / ischemia/reperfusion
© 2010 AMSECT
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