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ECMO for intractable status asthmaticus following atracurium

  • Case Report
  • Artificial Lung / ECMO
  • Published:
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Abstract

Intraoperative allergic reactions are rare but serious events associated with increased morbidity and mortality. We report the salvage of intraoperative anaphylaxis leading to extreme hypercapnic respiratory failure by veno-venous extracorporeal membrane oxygenation (ECMO). A 38-year-old woman undergoing thyroidectomy developed intractable bronchospasm after administration of atracurium, leading to extreme hypercapnic respiratory failure (PaCO2 > 250 mmHg, pH 6.773). After the failure of conventional medical therapy and ventilatory optimization, the patient was connected to a veno-venous ECMO circuit. PaCO2 of 45.6 mmHg and pH of 7.25 were achieved in 1 h, by slowly increasing sweep gas flows up to 3.5 L/min and using continuous end-tidal CO2 monitoring to gauge the procedure. After extubation and disconnection from ECMO, the patient was discharged on the 6th day without sequelae. Rapid reversal of extreme hypercapnic acidosis by ECMO was feasible, without any neurologic sequelae. Veno-venous ECMO support may be a valuable option for the salvage of intraoperative anaphylaxis.

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Acknowledgements

No further individuals contributed towards the article by means that do not meet the criteria for authorship.

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Authors and Affiliations

  1. Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, MI, Italy

    Vittorio Scaravilli, Giacomo Grasselli, Alberto Zanella & Antonio Pesenti

  2. Dipartimento di Anestesia e Terapia Intensiva, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy

    Annalisa Benini, Michela Bombino & Nicolò Patroniti

  3. Scuola di Medicina e Chirurgia, Università Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy

    Daniele Ceriani & Nicolò Patroniti

  4. Dipartimento di Anestesia e Terapia Intensiva, Ospedale San Biagio, Piazza Vittime dei Lager Nazifascisti 1, 28845, Domodossola, VB, Italy

    Uta Emmig

Authors
  1. Vittorio Scaravilli
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  2. Giacomo Grasselli
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  3. Annalisa Benini
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  4. Michela Bombino
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  5. Daniele Ceriani
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  6. Uta Emmig
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  7. Alberto Zanella
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  8. Nicolò Patroniti
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  9. Antonio Pesenti
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Corresponding author

Correspondence to Vittorio Scaravilli.

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The patient provided written informed consent for the publication of the following case report.

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Scaravilli, V., Grasselli, G., Benini, A. et al. ECMO for intractable status asthmaticus following atracurium. J Artif Organs 20, 178–181 (2017). https://doi.org/10.1007/s10047-016-0940-7

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  • DOI: https://doi.org/10.1007/s10047-016-0940-7

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