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Journal of Artificial Organs

, Volume 21, Issue 4, pp 475–478 | Cite as

Rapid-onset plasma leakage of extracorporeal oxygenation membranes possibly due to hyperbilirubinemia

  • Yoshiko Kida
  • Shinichiro OhshimoEmail author
  • Michihito Kyo
  • Yuko Tanabe
  • Kei Suzuki
  • Koji Hosokawa
  • Nobuaki Shime
Case Report Artificial Lung / ECMO

Abstract

Extracorporeal membrane oxygenation (ECMO) is an emerging tool for supporting cardiopulmonary function in patients with cardiorespiratory failure or arrest. The oxygenator of the ECMO circuit requires effective oxygenation and removal of carbon dioxide from the blood. Major problems that can occur with the oxygenator include plasma leakage, one of the late-onset serious complications necessitating device replacement. However, the rapid onset of plasma leakage is rare. We present a 1-year-old boy with acute respiratory failure due to Pneumocystis and Aspergillus pneumonia. He presented with tachypnea, tachycardia, and hypoxemia despite the ventilatory support, and was therefore placed on venoarterial ECMO with a drainage catheter from the right internal jugular vein (12 Fr) and a return catheter to the right internal carotid artery (10 Fr). Extracorporeal circulation was initiated at a blood flow of 1 L/min (145 mL/kg/min) and a sweep gas flow of 1 L/min with FiO2 of 0.7. Although he was successfully weaned from the venoarterial ECMO on day 15 with an improvement of cardiopulmonary function, he was later placed on venoarterial ECMO again because of the progression of pulmonary hypertension. Laboratory tests showed increased concentrations of hepatic enzymes and hyperbilirubinemia (total bilirubin 31.6 mg/dL). Six hours after starting ECMO circulation, plasma leakage from the oxygenator occurred. Although we replaced the oxygenator with a new one, the replacement showed plasma leakage after 6 h. Disassembly of the oxygenator revealed congestion from bilirubin in the membrane fibers. We described a case of repeated, rapid-onset plasma leakage after implementation of ECMO. Hyperbilirubinemia was likely associated with the plasma leakage of this patient.

Keywords

Oxygenator Bilirubin Children 

Abbreviations

ECMO

Extracorporeal membrane oxygenation

FIO2

Fraction of inspired oxygen

HFNC

High flow nasal cannula

ICU

Intensive care unit

PaCO2

Partial pressure of carbon dioxide

PaO2

Partial pressure of oxygen

VA

Venoarterial

Notes

Compliance with ethical standards

Availability of data and materials

None.

Source of funding

This work was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI (Grant numbers JP16K09541, JP17K17052, and JP17K11573), the Strategic Information and Communications R&D Promotion Programme (SCOPE), and the Japan Agency for Medical Research and Development (AMED).

References

  1. 1.
    Park TK, Yang JH, Jeon K, et al. Extracorporeal membrane oxygenation for refractory septic shock in adults. Eur J Cardiothorac Surg. 2015;47:e68–74.CrossRefGoogle Scholar
  2. 2.
    Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators, Davies A, Jones D, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA 2009;302:1888–95.CrossRefGoogle Scholar
  3. 3.
    Posluszny J, Rycus PT, Bartlett RH, et al. Outcome of adult respiratory failure patients receiving prolonged (≥ 14 days) ECMO. Ann Surg. 2016;263:573–81.CrossRefGoogle Scholar
  4. 4.
    Kind K, Reiss N, Knobl HJ, et al. Introduction of a new oxygenator including a tight fiber for long-term ECMO in infants. ASAIO J. 2006;52:217–8.CrossRefGoogle Scholar
  5. 5.
    Tatsumi E, Taenaka Y, Nakatani, et al. A VAD and novel high performance compact oxygenator for long-term ECMO with local anticoagulation. Trans Am Soc Artif Intern Organs. 1990;36:M480–3.Google Scholar
  6. 6.
    Thiara AP, Hoel TN, Kristiansen F, et al. Evaluation of oxygenators and centrifugal pumps for long-term pediatric extracorporeal membrane oxygenation. Perfusion. 2007;22:323–6.CrossRefGoogle Scholar
  7. 7.
    Akasu H, Anazawa T. Development of a membrane oxygenator using novel polyolefin hollow fibers with blind-ended micropores. Jpn J Biomater. 1990;8:141–7.Google Scholar
  8. 8.
    Meyns B, Vercaemst L, Vandezande E, et al. Plasma leakage of oxygenators in ECMO depends on the type of oxygenator and on patient variables. Int J Artif Organs. 2005;28:30–4.CrossRefGoogle Scholar
  9. 9.
    Montoya JP, Shanley CJ, Merz SI, et al. Plasma leakage through microporous membranes. Role of phospholipids. ASAIO J. 1992;38:M399–405.CrossRefGoogle Scholar
  10. 10.
    Eash HJ, Jones HM, Hattler BG, et al. Evaluation of plasma resistant hollow fiber membranes for artificial lungs. ASAIO J. 2004;50:491–7.CrossRefGoogle Scholar
  11. 11.
    Toomasian JM, Schreiner RJ, Meyer DE, et al. A polymethylpentene fiber gas exchanger for long-term extracorporeal life support. ASAIO J. 2005;51:390–7.CrossRefGoogle Scholar
  12. 12.
    Jacobsen J. Binding of bilirubin to human serum albumin—determination of the dissociation constants. FEBS Lett. 1969;5:112–4.CrossRefGoogle Scholar
  13. 13.
    Murrsy RK. Porphyrin and bile pigments. 24 ed Harper’s biochemistry. London: Appleton & Lange; 1996.Google Scholar
  14. 14.
    Wildschut ED, Ahsman MJ, Allegaert K, et al. Determinants of drug absorption in different ECMO circuits. Intensive Care Med. 2010;36:2109–16.CrossRefGoogle Scholar

Copyright information

© The Japanese Society for Artificial Organs 2018

Authors and Affiliations

  1. 1.Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan

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