Veno-Venous ECMO: An Alternative Strategy for Acute Respiratory Failure After High-Voltage Electrocution. The Utility of Point-of-Care Tests

Abstract

We report an extraordinary case of a 43-year-old man who sustained high-voltage electrocution injury associated with severe pulmonary damage due to current flow through the tissue. For the first time, a veno-venous extracorporeal membrane oxygenation (ECMO) was successfully used to provide respiratory support during severe hypoxemia without any limitation for surgical wound excision and homologous skin transplantation. To prevent over-bleeding due to surgery, daily medications and heparin infusion aggregometry and thromboelastometry were used as new point-of-care tests. After more than 400 hours, the patient returned to conventional ventilation with a significant improvement of gas exchanges, total pulmonary restore and without thromboembolic complications. Based on our experience, maximum clot firmness (MCF) in FIBTEM is usually high. Our finding shows that fibrinogen deficiency is not a leading mechanism for bleeding in burn patients also during ECMO; they need plasma transfusion preferably. About whole blood impedance aggregometry, thrombin receptor activating peptide 6-test (AUC) is strongly correlated to surgical bleeding and platelet consumption. We suggest that a rapid correction of coagulopathy, using ROTEM and MULTIPLATE, helps to minimize allogeneic blood products and to avoid thromboembolic complications during ECMO treatment and surgical burn wound excision.




J Med Cases. 2015;6(12):586-591
doi: http://dx.doi.org/10.14740/jmc2380e