A previously healthy 24-year-old male presented with fever, dry cough and diarrhea in Colbún (VII region).
Three days later, the chest X-ray showed mild left basal infiltrate and the laboratory tests: hematocrit of 46%, 6,100 white blood cells, 16% bacilliform, 92,000 platelets, gastrointestinal tract progression 79 133 U/L.
He was admitted to the ICU conscious, hypotensive, tachycardic, tachypnea, fever with APACHE II of 27 points and high oxygen requirements.
Pulmonary artery catheter (CAP) and PiCCO monitor (Pulsion Medical System, Munich, Germania) were installed and results suggested pulmonary edema permeability10,11.
Six hours later she was connected to mechanical ventilation.
1.
At 29 h, his cardiorespiratory condition deteriorated, despite the progressive increase in vasoactive support and optimization of mechanical ventilation, seeking a minimal hemodynamic impact
Table 1.
With these parameters it was decided connection to extracorporeal cardiopulmonary support via veno-arterial femoral-femoral, with 21 and 19 French cannulas (Biomedicus, Medtronic, Grand USA) under systemic anticoagulation, MI.
Venoarterial shunt.
Venous drainage was performed from the right atrium to a magnetic centrifugal pump (Sarns Inc/3M, Ann Arnea, Mich.) and Medtros, NT perforated fibers ( Minffina).
The descending aorta was returned to the left femoral artery.
Pump flow was progressively started at L/min and increased to 5.3 L/min at 12 h.
Arterial pH, SaO2 and SvO2 improved, but the superior cyanotic hemibody gave rise to a referral of blood to the central venous system.
Table 1.
1.
Venoarterial/arterial-venous shunt (ECLS/VA-AV).
A 11F double-lumen catheter was placed in the left internal jugular vein.
Both lumens received postprandial blood with a blood flow of 300 ml/min in each lumen.
Due to acute renal failure, continuous renal replacement therapy was interposed in one of the lumens.
Thus, a mixed shunt was created, after which the patient gradually improved, allowing, on the third day, to reduce the FiO2 to 30%, to withdraw the continuous infusion pump/kg and to reduce the norepinephrine to 0.1 μmin.
At 102 h, the A-V shunt was removed, when nitroglycerin infusion was administered to control the increase in pulmonary arterial pressure.
The patient was maintained with the pump flow at 3 L/min for 2 h.
Subsequently, the flow was reduced by 1 L/min every two hours until suspension.
As a precaution, the pump was removed using an extracorporeal line (puente) for one hour. After this, cannulas were removed after 110 h in ECLS.
Seven days later, the patient was extubated and discharged from the ICU after 21 days.
Table 1.
