Veno-venous extracorporeal membrane oxygenation in obese surgical patients with hypercapnic lung failure

Abstract

ECMO in obese patients is feasible and life saving. Therefore, a percutaneous cannulation remains feasible. The goals of the ECMO therapy include early spontaneous breathing, tracheotomy, rapid reduction of sedation and adequate analgesia. Rehabilitation includes nutritional therapy, as well as psychiatric therapy and bariatric surgery, as perspectives for the future.

Extremely obese patients treated with venovenous ECMO—an intensivist’s challenge

“…These case reports showed that extracorporeal lung support is a feasible treatment option for extremely obese patients with ARDS, a finding that was previously described [9,10]. After weaning from ECMO, 1 patient required noninvasive ventilation support; the other died of multiorgan failure due to secondary sepsis.…”

“…A BMI higher than 40 kg/m 2 seems to be associated with an increased risk of developing acute respiratory distress syndrome (ARDS) along with greater morbidity, length of stay, and duration of mechanical ventilation in the intensive care unit (ICU) [8]. However, extreme obesity is not a risk factor for hospital mortality in patients with acute lung failure and is not a contraindication for venovenous extracorporeal membrane oxygenation (vv ECMO) implantation [9,10]. We report on 2 cases of surgically treated patients (BMI N 70 kg/m 2 ) with postoperative ARDS and ECMO support.…”

Venovenous Extracorporeal Membrane Oxygenation as a Treatment for Obesity Hypoventilation Syndrome

“…The second patient, who had a BMI of 88.6 kg/m 2 , developed severe ARF because of sepsis after treatment of necrotizing fasciitis, and VV-ECMO was indicated [11]. Extreme obesity is not a contraindication for VV-ECMO implantation [12–14]. However, treating extremely obese patients with VV-ECMO poses a special challenge for intensivists.…”

“…However, treating extremely obese patients with VV-ECMO poses a special challenge for intensivists. Femorojugular venovenous percutaneous cannulation is associated with several pitfalls including difficulty locating the anatomical landmarks and the inability to visualize the blood vessels sonographically [14]. The cannulation procedure must be performed by experienced practitioners.…”

Successful non-surgical management of pleuroparenchymal fistula following cervical intraspinal empyema

“…Extracorporeal membrane oxygenation (ECMO) for lung support was also considered for this patient. Veno-venous ECMO for patients with lung failure has been performed in this ICU since 2008, but clinicians were concerned about the use of ECMO as a rescue option in this case [9]. The use of ECMO to treat PPF has shown promising results in case reports because it can provide a therapeutic bridge to lung-protective ventilation and the remainder of the lung and allows for PPF closure [10][11][12][13].…”