Severe transfusion-related acute lung injury managed with extracorporeal membrane oxygenation (ECMO) in an obstetric patient

Lee, Allison J.; Koyyalamudi, Pushpa; Martinez-Ruiz, Ricardo

doi:10.1016/j.jclinane.2008.05.019

Cited by 22 publications

(13 citation statements)

References 13 publications

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“…However, hypotension is a common sign in TRALI and usually does not respond to IV fluid infusion. V-A ECMO was selected for the treatment of patients who appeared to be at near cardiac arrest, although respiratory failure usually requires only V-V ECMO [8].…”

Section: Discussionmentioning

confidence: 99%

Kayo Sugiyama*, Hirotaka Watanuki, Masaho Okada, Yasuhiro Futamura, Atomu Tajima, Rokuki Kiyosawa, Katsuhiko Matsuyama

Sugiyama¹,

Watanuki²,

Okada³

et al. 2018

OJTS

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Transfusion-related acute lung injury (TRALI) is characterized by acute severe hypoxemia with bilateral noncardiogenic pulmonary edema after transfusion of a plasma-containing blood component. In patients undergoing cardiac surgery, the incidence of TRALI is high; however, the detailed clinical course is unknown. Here, we report a case of life-threatening TRALI following pulmonary thrombectomy, which was successfully treated with extracorporeal membranous oxygenation (ECMO).

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Section: Discussionmentioning

confidence: 99%

Kayo Sugiyama*, Hirotaka Watanuki, Masaho Okada, Yasuhiro Futamura, Atomu Tajima, Rokuki Kiyosawa, Katsuhiko Matsuyama

Sugiyama¹,

Watanuki²,

Okada³

et al. 2018

OJTS

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“…While the literature contains examples of ECMO support being provided for peripartum women with conditions such as acute respiratory distress syndrome caused by H1N1 influenza [3,4], peripartum cardiomyopathy [5], amniotic fluid embolism [6] and transfusion-related acute lung injury [7], we found little mention of ECMO being used to manage peripartum patients with massive bleeding [8]. Generally, use of ECMO is indicated when there is life-threatening cardiac and respiratory failure and no other treatment is likely to be successful.…”

Section: Discussionmentioning

confidence: 99%

Successful use of extracorporeal membrane oxygenation in the reversal of cardiorespiratory failure induced by atonic uterine bleeding: a case report

et al. 2014

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IntroductionAlthough extracorporeal membrane oxygenation has made sufficient progress to be considered for the management of life-threatening cardiac and respiratory failure, the risk of hemorrhagic complications may outweigh the benefits for patients with bleeding tendencies. We report, to the best of our knowledge, the first case of successful treatment by extracorporeal membrane oxygenation, without any hemorrhagic complications, of postpartum cardiorespiratory failure after massive uterine bleeding.Case presentationA 25-year-old Japanese woman experienced massive atonic bleeding after delivering her second baby. Recovery from hemorrhagic shock was managed by conservative treatments, but she developed decompensated heart failure and refractory hypoxia. Because we could not obtain hemodynamic stability and proper oxygenation even with high doses of catecholamines and maximal ventilator settings, we administered venoarterial extracorporeal membrane oxygenation, whereupon her hemodynamic status immediately stabilized. After 72 hours of support without major bleeding, extracorporeal membrane oxygenation was successfully withdrawn.ConclusionEven in cases of obstetric bleeding, if clotting status is stringently monitored, extracorporeal membrane oxygenation can be considered as an ultimate means of life support.

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“…In rare cases, the hypoxemia resulting from TRALI can be so severe that extracorporeal membrane oxygenation may be required as a temporizing measure while the lungs heal. 25,26 Potentially harmful interventions, such as the administration of diuretics, should be avoided. In fact, patients with TRALI who are hypotensive may require intravenous fluids to maintain an adequate blood pressure.…”

Section: Discussionmentioning

confidence: 99%

TRALI in the perioperative period

Berdaï¹,

Labib²,

Harandou³

2014

IJCTM

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Background: Transfusion-related acute lung injury (TRALI) is one of the leading causes of transfusion-related morbidity and mortality. Although it is a serious complication of blood transfusion, it is still underestimated because of underrecognition and misdiagnosis, which can lead to inappropriate management. Case report: We report the case of a 34-year-old female, who presented with hemorrhagic shock during cesarean section and was transfused with packed red blood cells and fresh frozen plasma. Three hours after the end of transfusion, while still intubated, the patient developed acute respiratory failure, with diffuse crackles at auscultation and bilateral lung infiltrations on chest radiography. The ratio of the arterial partial pressure of O 2 and the fraction of inspired O 2 (PaO 2 /FiO 2) was 51. The diagnosis of TRALI was made after excluding other possible causes of acute lung injury. She was managed symptomatically with ventilatory support and vasopressors. The patient later died secondary to multiple organ failure. Conclusion: The diagnosis of TRALI relies on the exclusion of other causes of acute pulmonary edema following transfusion. All plasma-containing blood products have been involved in the genesis of this syndrome. This is a relatively common and serious adverse transfusion reaction that requires prompt diagnosis and management. Challenges are ahead as preventive strategies have reduced but not eliminated the onset of TRALI.

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Severe transfusion-related acute lung injury managed with extracorporeal membrane oxygenation (ECMO) in an obstetric patient

Cited by 22 publications

References 13 publications

Kayo Sugiyama*, Hirotaka Watanuki, Masaho Okada, Yasuhiro Futamura, Atomu Tajima, Rokuki Kiyosawa, Katsuhiko Matsuyama

Kayo Sugiyama*, Hirotaka Watanuki, Masaho Okada, Yasuhiro Futamura, Atomu Tajima, Rokuki Kiyosawa, Katsuhiko Matsuyama

Successful use of extracorporeal membrane oxygenation in the reversal of cardiorespiratory failure induced by atonic uterine bleeding: a case report

TRALI in the perioperative period

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