Veno-venous extracorporeal membrane oxygenation for a Stanford type A aortic dissection patient combined with postoperative respiratory failure and COVID-19: A case report_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHAO Hongan , YAO Yue , WANG Bo , WANG Lu , HU Jing ,  LI Qingguo

Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, P. R. China;

Corresponding author：

LI Qingguo, Email: liqg@njmu.edu.cn

Keywords：

Aortic dissection; respiratory failure; extracorporeal membrane oxygenation; COVID-19

DOI：

10.7507/1007-4848.202302074

Video：

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During the new coronavirus disease 2019 (COVID-19) pandemic, there has been controversy over whether emergency surgical management should be performed or not in the patients with COVID-19. Stanford type A aortic dissection is a very urgent life-threatening disease, and guidelines recommend surgical treatment for patients with type A aortic dissection in the first instance. However, intraoperative extracorporeal circulation can be fatal to patients recovering from COVID-19. During the pandemic, extracorporeal membrane oxygenation (ECMO) has played an important role in supporting COVID-19 patients with acute respiratory failure. This article reports a successful V-V ECMO treatment for a Stanford type A aortic dissection patient, who suffered respiratory failure caused by COVID-19 after emergency surgery.

Citation： SHAO Hongan, YAO Yue, WANG Bo, WANG Lu, HU Jing, LI Qingguo. Veno-venous extracorporeal membrane oxygenation for a Stanford type A aortic dissection patient combined with postoperative respiratory failure and COVID-19: A case report. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(7): 967-969. doi: 10.7507/1007-4848.202302074 Copy

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2.	Malaisrie SC, Szeto WY, Halas M, et al. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg, 2021, 162(3): 735-758.
3.	Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
4.	Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 146(24): e334-e482.
5.	De Paulis S, Arlotta G, Calabrese M, et al. Postoperative intensive care management of aortic repair. J Pers Med, 2022, 12(8).
6.	Xing Z, Han J, Hao X, et al. Immature monocytes contribute to cardiopulmonary bypass-induced acute lung injury by generating inflammatory descendants. Thorax, 2017, 72(3): 245-255.
7.	Huffmyer JL, Groves DS. Pulmonary complications of cardiopulmonary bypass. Best Pract Res Clin Anaesthesiol, 2015, 29(2): 163-175.
8.	Collaborative CO. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study. Lancet, 2020, 396(10243): 27-38.
9.	Collaborative CO. Outcomes and their state-level variation in patients undergoing surgery with perioperative SARS-CoV-2 infection in the USA: A prospective multicenter study. Ann Surg, 2022, 275(2): 247-251.
10.	Kiyatkin ME, Levine SP, Kimura A, et al. Increased incidence of post-operative respiratory failure in patients with pre-operative SARS-CoV-2 infection. J Clin Anesth, 2021, 74: 110409.
11.	Brodie D, Slutsky AS, Combes A. Extracorporeal life support for adults with respiratory failure and related indications: A review. JAMA, 2019, 322(6): 557-568.
12.	Supady A, Combes A, Barbaro RP, et al. Respiratory indications for ECMO: Focus on COVID-19. Intensive Care Med, 2022, 48(10): 1326-1337.
13.	Tramm R, Ilic D, Davies AR et al. Extracorporeal membrane oxygenation for critically ill adults. Cochrane Database Syst Rev, 2015, 1(1): CD010381.

1. Collaborative CO, GlobalSurg C. Timing of surgery following SARS-CoV-2 infection: An international prospective cohort study. Anaesthesia, 2021, 76(6): 748-758.
2. Malaisrie SC, Szeto WY, Halas M, et al. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg, 2021, 162(3): 735-758.
3. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
4. Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 146(24): e334-e482.
5. De Paulis S, Arlotta G, Calabrese M, et al. Postoperative intensive care management of aortic repair. J Pers Med, 2022, 12(8).
6. Xing Z, Han J, Hao X, et al. Immature monocytes contribute to cardiopulmonary bypass-induced acute lung injury by generating inflammatory descendants. Thorax, 2017, 72(3): 245-255.
7. Huffmyer JL, Groves DS. Pulmonary complications of cardiopulmonary bypass. Best Pract Res Clin Anaesthesiol, 2015, 29(2): 163-175.
8. Collaborative CO. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study. Lancet, 2020, 396(10243): 27-38.
9. Collaborative CO. Outcomes and their state-level variation in patients undergoing surgery with perioperative SARS-CoV-2 infection in the USA: A prospective multicenter study. Ann Surg, 2022, 275(2): 247-251.
10. Kiyatkin ME, Levine SP, Kimura A, et al. Increased incidence of post-operative respiratory failure in patients with pre-operative SARS-CoV-2 infection. J Clin Anesth, 2021, 74: 110409.
11. Brodie D, Slutsky AS, Combes A. Extracorporeal life support for adults with respiratory failure and related indications: A review. JAMA, 2019, 322(6): 557-568.
12. Supady A, Combes A, Barbaro RP, et al. Respiratory indications for ECMO: Focus on COVID-19. Intensive Care Med, 2022, 48(10): 1326-1337.
13. Tramm R, Ilic D, Davies AR et al. Extracorporeal membrane oxygenation for critically ill adults. Cochrane Database Syst Rev, 2015, 1(1): CD010381.

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Veno-venous extracorporeal membrane oxygenation for a Stanford type A aortic dissection patient combined with postoperative respiratory failure and COVID-19: A case report

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