2001 OPEN FORUM Abstracts
ECMO AsA Bridge To Interventional Catheterization: A Case Report
Jenni L. Raake, BS,RRT, David S. Cooper, MD, MPH, LubabatuAbdurrahman, MD, Steven M.Schwartz, MD, David P. Nelson, MD, Ph.D. Children?s Hospital Medical Center,Cincinnati, OH
Introduction:ECMO is valuable in the treatment of infants with severe reversible respiratorydisease or severe reversible, low cardiac output refractory to medical management.This case study reports successful use of ECMO as a bridge to interventionalcatheterization in a patient with multiple left-sided heart obstructive lesionsand severe left ventricular dysfunction.
Case Summary:A.S. is a three month old infant who presented to a local emergency departmentin cardiogenic shock with subsequent cardiorespiratory arrest. Resuscitationefforts included intubation, ventilation, dobutamine, dopamine, and ultimatelyhigh dose epinephrine. Diagnostic echocardiogram revealed severe coarctationof the aorta, severe aortic stenosis, markedly depressed left ventricular function(5% ejection fraction) and left atrial and left ventricular dilation. The patientwas transported to Children?s Hospital Medical Center and rapidly placed onECMO due to refractory low cardiac output despite high dose epinephrine therapy.After a 40-hour stabilization period, the patient was transported to the cardiaccatheterization laboratory on ECMO for balloon dilation of both the aortic valveand coarctation. The patient was decannulated from ECMO the next day, extubatedtwo days post-dilation, and transferred back to the referring hospital fourdays post-dilation. Echocardiogram on discharge revealed markedly improved leftventricular function (ejection fraction 65%) and moderate aortic stenosis (peakgradient 34 mm Hg, mean gradient 18 mm Hg).
Significance:Interventional catheterization on ECMO is often avoided due to inherent risksand associated complexities. This case illustrates a dramatic recovery usingthe combination of ECMO and catheter intervention in a situation where surgicalintervention would have been difficult. Consequently, use of ECMO as a bridgefor interventional catheterization may be a treatment option in critically illpatients with refractory low cardiac output due to a correctable cardiac lesion.