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Case Reports
. 2021 Oct 8;15(1):499.
doi: 10.1186/s13256-021-03050-7.

Massive aspiration syndrome: a possible indication for "emergent" veno-venous extracorporeal membrane oxygenation?: a case report

Emiliano Gamberini  1 , Venerino Poletti  2 , Emanuele Russo  3 , Alessandro Circelli  3 , Marco Benni  3 , Giovanni Scognamiglio  3 , Domenico Pietro Santonastaso  3 , Costanza Martino  3 , Linda Domenichini  3 , Romina Biondi  3 , Giorgia Bastoni  4 , Etrusca Brogi  5 , Luca Ansaloni  6 , Federico Coccolini  7 , Paola Fugazzola  4 , Martina Spiga  3 , Vanni Agnoletti  3
Affiliations
Case Reports

Massive aspiration syndrome: a possible indication for "emergent" veno-venous extracorporeal membrane oxygenation?: a case report

Emiliano Gamberini et al. J Med Case Rep. .

Abstract

Background: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is usually performed in cases of severe respiratory failure in which conventional and advanced mechanical ventilation strategies are ineffective in achieving true lung-protective ventilation, thus triggering ventilatory-induced lung injury. If circulatory failure coexists, veno-arterial ECMO (VA-ECMO) may be preferred over VV-ECMO because of its potential for circulatory support. In VA-ECMO, the respiratory contribution is less effective and the complication rate is higher than in the VV configuration.

Case presentation: The authors present a case in which VV-ECMO was performed in an emergency setting to treat a 68-year-old White male patient who experienced acute respiratory failure after massive aspiration. Despite intubation and intensive care unit admission, multiple organ failure occurred suddenly, thus prompting referral to a level-1 trauma center with an ECMO facility. The patient's condition slowly improved with VV-ECMO support along with standard treatment for hemodynamic impairment. VV-ECMO was discontinued on day 8. The patient was extubated on day 14 and discharged home fully recovered 34 days after the event.

Conclusions: Attention was focused on the decision to initiate VV-ECMO support even in the presence of severe hemodynamic derangement, although VA-ECMO could have provided better hemodynamic support but less effective respiratory support.

Keywords: ECMO; ICU; Massive aspiration; Shock.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
First arterial blood gas test on admission to the level-1 hospital
Fig. 2
Fig. 2
X-ray control for placement of cannulas for veno-venous extracorporeal membrane oxygenation. White arrow pointing the tip of the return cannula in superior vena cava while black arrow pointing the tip of the drainage cannula in inferior vena cava
Fig. 3
Fig. 3
A Chest X-ray performed immediately after massive aspiration. B Chest X-ray 4 hours later in a level-2 hospital intensive care unit. C Lung computed tomography after initiation of veno-venous extracorporeal membrane oxygenation and clinical improvement in the level-1 hospital
Fig. 4
Fig. 4
Extracorporeal centrifugal pump with membrane gas exchanger at the bedside
See this image and copyright information in PMC

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