THIS case is presented to illustrate the possible roles of factors that relieve arterial hypoxemia during partial venous-arterial extracorporeal oxygenator support (ECOS).1
Report of a Case
The patient was a 50-year-old man with a one-year history of rheumatic heart disease. Medical management had been virtually absent because of his refusal to consult a physician regularly. He was admitted to the emergency ward with refractory pulmonary edema and immediately suffered a cardiac arrest. Resuscitation was difficult, requiring nearly three hours, with repeated episodes of cardiac arrest. Cardiac catheterization was not thought advisable because of his critical condition. Six hours after admission, while he was still hypotensive and in coma, replacement of the aortic and mitral valves was performed. After surgery, reexploration was required twice because of bleeding. He was treated with increasing amounts of isoproterenol and dopamine hydrochloride, but remained anuric and hypotensive. Because of rapid atrial fibrillation, counterpulsation by
Don H, Drinker PA, Hanson EL, Collins JJ. Arterial Oxygenation: Mechanisms for Improvement During Partial Cardiopulmonary Support. JAMA. 1974;228(11):1419–1420. doi:10.1001/jama.1974.03230360049026
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