Veno-Venous Extra-Corporeal Membrane Oxygenation (ECMO) in a Child with Hemoptysis and Fontan Circulation

Abstract

Background: Extracorporeal membrane oxygenation is a rescue life support technique used in life threatening conditions of refractory respiratory and/or cardiac distress. Indication for extracorporeal life support in children depends on age and varies from pulmonary to cardiac pathologies. In some cases, it may be used as a bridge to a therapeutic procedure. We described here the management of respiratory failure due to hemoptysis in a child with a Fontan circulation and veno-venous extracorporeal membrane oxygenation which served as a bridge to angio-embolization. Hemoptysis can be a life threatening condition which can lead to hypovolemic shock and impaired alveolar gas exchange. The latter can result in respiratory failure and consequent asphyxia. When hemoptysis occurs in a patient with a univentricular heart and a Fontan circulation, management of this clinical situation can be challenging due to the particular physiology of the latter. Total cavopulmonary connection is a palliative surgical repair which constitutes Fontan circulation as a definitive treatment in patients with a univentricular heart. Methods: Case report description of a 16 year-old boy with a univentricular heart and a Fontan circulation who presented hemoptysis managed with a veno-venous extracorporeal membrane oxygenation (ECMO) as a bridge to an

Physiology Principles Underlying Goal Directed Therapies in Children

“…Considering the goal directed fluid and hemodynamic therapy (GDFHT) point of view [9][10][11][12][13][14][15][16][17][18][19][20]. The objectives of the GDFHT are to optimize DO 2 to the tissues and tissular VO 2 .…”

“…DO 2 can be optimized in GDFHT by increasing CO. CO can be increased by optimizing SV. SV can be assessed echocardiographically with aortic peak velocity variation (ΔVpeak), aortic velocity time integral (VTI) and distance minute (DM) at the aortic valve [9][10][11][12][13][14][15][16][17][18][19][20]. Assessing aortic velocity time integral (VTI) and aortic peak velocity variation (ΔVpeak) will determine fluid responsiveness if fluid therapy with crystalloids and or colloids is necessary or vasopressor-inotropic therapy to increase SV and thus cardiac output [14].…”