Circulatory Assistance in a Patient with Respiratory Failure

  • Rafael Ramos Amaral
  • Thiago do Amaral Cavalcante
  • Leonardo Jadyr Silva Rodrigues Alves
  • Helmgton José Brito de Souza


Acute respiratory distress syndrome is a disease in which the lungs suffer from severe inflammation with hypoxemia and respiratory failure. This interferes with lung compliance and results in bilateral and diffuse damage. Its etiology may be infective or non-infective. Treatment for this disorder includes, in severe cases, the use of circulatory assistance devices such as ECMO (extracorporeal membrane oxygenation), which allows patients with respiratory or cardiac failure to be on circulatory assistance outside the operating room under observation. Here we present the case of a 33-year-old man who was admitted to the emergency room with respiratory failure after a suicide attempt with a blunt weapon. He was placed on mechanical ventilation, being diagnosed, after emergency intubation, with a bilateral pneumothorax. Following a bilateral thoracic drainage, he was transferred to the intensive care unit, rapidly developing respiratory infection and acute respiratory distress syndrome (ARDS), failing to respond after prone positioning and alveolar recruitment. Considering the worsening infection and multiple organ failure and in order to prevent imminent death, he was placed on veno-venous extracorporeal membrane oxygenation (VV-ECMO). Progressive improvement was evident from the fourth day following the ECMO installment, and the device was explanted at the eighth day, after significant recovery. ECMO proved to be an effective measure to improve acute respiratory distress syndrome in this patient.


  1. 1.
    Peek GJ, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet (London, England). 2009;374(9698):1351–63.CrossRefGoogle Scholar
  2. 2.
    Harlan BJ, Starr A, Harwin FM. Manual Ilustrado de Cirurgia Cardíaca. 1a edn. Revinter; 2000.Google Scholar
  3. 3.
    Stoney WS. Evolution of cardiopulmonary bypass. Circulation. 2009;119(21):2844–53. Scholar
  4. 4.
    Gaffney AM, Wildhirt SM, Griffin MJ, Annich GM, Radomski MW. Extracorporeal life support. BMJ. 2010;341(nov02 1):c5317. Scholar
  5. 5.
    Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988;138(3):720–3. Scholar
  6. 6.
    Extracorporeal Life Support Organization (ELSO). General guidelines for all ecls cases (Version 1.3). Extracorporeal Life Support Organization; 2013.
  7. 7.
    Pierrakos C, et al. Acute respiratory distress syndrome: pathophysiology and therapeutic options. J Clin Med Res. 2012;4(1):7–16.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Dushianthan A, Grocott MPW, Postle AD, Cusack R. Acute respiratory distress syndrome and acute lung injury. Postgrad Med J. 2011;87(1031):612–22. Scholar
  9. 9.
    Bosarge PL, Raff LA, McGwin G, Carroll SL, Bellot SC, Diaz-Guzman E, Kerby JD. Early initiation of extracorporeal membrane oxygenation improves survival in adult trauma patients with severe acute respiratory distress syndrome. J Trauma Acute Care Surg. 2016;1.
  10. 10.
    Jacobs JV, Hooft NM, Robinson BR, Todd E, Bremner RM, Petersen SR, Smith MA. The use of extracorporeal membrane oxygenation in blunt thoracic trauma. J Trauma Acute Care Surg. 2015;79(6):1049–54. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Rafael Ramos Amaral
    • 1
  • Thiago do Amaral Cavalcante
    • 1
  • Leonardo Jadyr Silva Rodrigues Alves
    • 1
  • Helmgton José Brito de Souza
    • 1
  1. 1.Unified School of Brasília (UNICEUB)BrasíliaBrazil

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