Korean J Crit Care Med.  2015 May;30(2):109-114. 10.4266/kjccm.2015.30.2.109.

Early Extracorporeal Membrane Oxygenation for Massive Aspiration during Anesthesia Induction

• Kim N
• Kim KH
• Kim JM
• Choi SY
• Na S

• KMID: 2227675
• DOI: http://doi.org/10.4266/kjccm.2015.30.2.109

Abstract

Although the incidence is not high in the general surgical population, pulmonary aspiration of gastric contents can result in serious long-term morbidity and mortality. We report a case of early use of extracorporeal membrane oxygenation (ECMO) to correct severe hypoxemia refractory to conventional mechanical ventilation in a patient with massive aspiration of gastric contents immediately followed by acute lung injury during general anesthesia induction. A 64-year-old woman diagnosed with stomach cancer was scheduled for elective diagnostic laparoscopy. Although there was no sign of gastrointestinal tract obstruction and midnight Nil per Os (NPO) was performed before the operation, pulmonary aspiration occurred during the induction of anesthesia. Despite the endotracheal intubation with mechanical ventilation, severe hypoxemia with hypercapnea persisted. Medical team agreed with applying veno-venous (VV) ECMO, and her blood gas analysis results became stable. ECMO was weaned successfully 9 days after the first aspiration event had occurred. Based on this case, early application of extracorporeal life support can have survival benefits.

Keyword

acute lung injury; aspiration pneumonia; extracorporeal membrane oxygenation

MeSH Terms

Acute Lung Injury
Anesthesia*
Anesthesia, General
Anoxia
Blood Gas Analysis
Extracorporeal Membrane Oxygenation*
Female
Gastrointestinal Tract
Humans
Incidence
Intubation, Intratracheal
Laparoscopy
Middle Aged
Mortality
Pneumonia, Aspiration
Respiration, Artificial
Stomach Neoplasms

Figure

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  Fig. 1. Chest radiograph; (A) Preoperation; (B) After ECMO; (C) On IOD #2, ECMO day #2; (D) On IOD #6, after ECMO weaning; (E) On IOD #9, before extubation; (F) On IOD #9, after extubation.

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  Fig. 2. Timeline of clinical events.

Reference

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