Veno-Venous Extracorporeal Membrane Oxygenation for Fat Embolism

Abstract

Pulmonary fat embolism is an infrequent but a serious complication of major trauma. Patients can suffer severe respiratory failure with sudden and unexpected onset, which can happen within 24 hours of trauma. The spectrum of presentations can vary from mild shortness of breath to sudden death. When respiratory failure ensues the clinical and radiological presentation resembles acute respiratory distress syndrome (ARDS). There is no evidence-based specific treatment for the condition, and conventional respiratory support often leads to recovery. In extreme cases the resulting hypoxemia and hypercarbia can be fatal. In other ARDS cases temporary support with extracorporeal membrane oxygenation (ECMO) can offer 65% survival (ELSO registry data). However, in cases of fat embolism the fat load can be transferred to the oxygenator and impact its function, and there is a scarcity of published data, leading to a relative reluctance to provide such support. We present a case of a 32-year-old patient following from traumatic bilateral below knee amputations. He suffered from pulmonary fat embolism leading to ARDS, which could not be adequately supported by conventional mechanical ventilation of the lungs. We considered the disadvantages of oxygenator malfunction due to fat loading, as well as the need for early oxygenator replacement. However, on the grounds of good prognosis for recovery, and potential for a short term ECMO support, the decision was made to commence veno-venous ECMO. Support on VV ECMO for total of 6 days allowed successful respiratory recovery and subsequent discharge home with ongoing rehabilitation.




J Med Cases. 2014;5(9):488-490
doi: http://dx.doi.org/10.14740/jmc1877e