SUCCESSFUL VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION FOR LEFT DIAPHRAGMATIC HERNIA AND SUPRASYSTEMIC PULMONARY HYPERTENSION IN A NEONATE

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Abstract

Extracorporeal membrane oxygenation (ECMO) was firstly used in 1977 for the treatment of congenital diaphragmatic hernia (CDH) in a neonate. The first time ECMO was administered in our country to a child with CDH on the 10th of January, 2013, at the intensive care department of Municipal Pediatric Hospital No. 13 named after N.F. Filatov. However, the first patient with CDH who had received ECMO, had survived decannullation and had been discharged from the hospital arrived to this hospital only on the 12th of October, 2015. The aim of ECMO was to stabilize the child’s condition and to obtain an opportunity of surgical correction of the congenital malformation. Indications included increasing cardiopulmonary failure, hypoxemia (РаО2<35 mm Hg, oxygenation index on the background of the high-frequency ventilation> 50, the alveolar-arterial oxygen gradient> 600 for 8 hours), combined acidosis, hypotension, suprasystemic pulmonary hypertension (main pulmonary artery pressure was higher than 100 mm Hg). There were no technical issues or complications during the procedure. Hemostatic therapy under the Activated Clotting Time (ACT) supervision, artificial lung ventilation (ALV), intravenous fluid and transfusion therapy were carried out. Cardiotonic therapy was canceled after the beginning of veno-arterial ECMO due to hemodynamic stabilization. Protective artificial ventilation was applied: VR-20; Pin-18mbar; PEEP-7mbar; FiO2-0,21. ACT was kept at 203 seconds in average at the average heparin infusion speed of 4 unit/kg/hour. Acidbase balance indicatiors: рН-7,38; РаО2-121,7 mm Hg, РаСО2-44,0 mm Hg, ВЕ-3,3, lactate 1,3. Average central venous pressure was 6,6 mm Hg., average invasive blood pressure - 51 mm Hg. After 72 hours of artificial circulatory support ECMO was canceled and surgical intervention was started after gas exchange and hemodynamic stabilization.

About the authors

I. I. Afukov

Municipal Pediatric Hospital No. 13 named after N.F. Filatov; Pirogov Russian National Research Medical University

Author for correspondence.
Email: afukovdoc@yandex.ru
Russian Federation

S. M. Stepanenko

Pirogov Russian National Research Medical University

Email: noemail@neicon.ru
Russian Federation

E. V. Zilbert

Municipal Pediatric Hospital No. 13 named after N.F. Filatov; Pirogov Russian National Research Medical University

Email: noemail@neicon.ru
Russian Federation

A. D. Kulaev

Municipal Pediatric Hospital No. 13 named after N.F. Filatov

Email: noemail@neicon.ru
Russian Federation

T. O. Svetlichnaya

Municipal Pediatric Hospital No. 13 named after N.F. Filatov

Email: noemail@neicon.ru
Russian Federation

A. B. Alkhasov

Municipal Pediatric Hospital No. 13 named after N.F. Filatov; Pirogov Russian National Research Medical University

Email: noemail@neicon.ru
Russian Federation

Z. B. Mitupov

Municipal Pediatric Hospital No. 13 named after N.F. Filatov; Pirogov Russian National Research Medical University

Email: noemail@neicon.ru
Russian Federation

O. G. Mokrushina

Municipal Pediatric Hospital No. 13 named after N.F. Filatov; Pirogov Russian National Research Medical University

Email: noemail@neicon.ru
Russian Federation

P. E. Biryukov

Municipal Pediatric Hospital No. 13 named after N.F. Filatov

Email: noemail@neicon.ru
Russian Federation

V. A. Strelkov

Municipal Pediatric Hospital No. 13 named after N.F. Filatov

Email: noemail@neicon.ru
Russian Federation

I. O. Tsvetkov

Municipal Pediatric Hospital No. 13 named after N.F. Filatov

Email: noemail@neicon.ru
Russian Federation

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Copyright (c) 2016 Afukov I.I., Stepanenko S.M., Zilbert E.V., Kulaev A.D., Svetlichnaya T.O., Alkhasov A.B., Mitupov Z.B., Mokrushina O.G., Biryukov P.E., Strelkov V.A., Tsvetkov I.O.

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