Use of a Daily Lung Compliance Evaluation to Track Progress on ECMO: Successful Use in a Patient With Cystic Fibrosis

Samer Abu-Sultaneh, Shekhar S. Raj, Brian D Benneyworth, A. Ioana Cristea, Mara E. Nitu, Mark R. Rigby

Abstract


Survival rates of extracorporeal membrane oxygenation (ECMO) for pediatric respiratory failure have been improving and are now about 70%. With this, traditional exclusionary criteria for ECMO may be challenged. We hypothesize that an objective evaluation of pulmonary recovery whilst on ECMO may assist in the care of high risk patients, such as those with cystic fibrosis (CF), both to strategize appropriate decannulation and avoid futility. A 19-year-old female with CF developed septic shock and MRSA-associated acute respiratory distress syndrome. After 4 days, her respiratory status deteriorated and was transitioned to veno-venous ECMO. Due to uncertainty of pulmonary recovery and survival, we instituted a “daily lung compliance trial” (DLCT) to objectively assess pulmonary compliance and function. This included increasing ventilatory support from “rest settings” to moderate non-toxic setting and assessing pulmonary pressures and compliances after 30 min. This provided objective data of lung healing. Due in part to this data, the patient was decannulated from ECMO after 11 days and successfully extubated 2 days later. ECMO can be used for CF patients with acute respiratory failure as a bridge to recovery. Using a DLCT can help guide decision making for respiratory ECMO patients with significant co-morbidities.




J Med Cases. 2014;5(2):83-88
doi: http://dx.doi.org/10.14740/jmc1511w

Keywords


Extracorporeal membrane oxygenation; Extracorporeal life support; Cystic fibrosis; Lung compliance; Acute respiratory distress syndrome; Extracorporeal life support organization

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