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Original article

Vol. 148 No. 2728 (2018)

Venovenous extracorporeal membrane oxygenation to treat hypercapnia in a morbidly obese patient

DOI
https://doi.org/10.57187/smw.2018.14639
Cite this as:
Swiss Med Wkly. 2018;148:w14639
Published
12.07.2018

Abstract

Morbid obesity plays an increasingly important role in healthcare. Patients who are severely obese often suffer from a range of medical problems. One problem is obesity-related hypoventilation syndrome with its resulting hypercapnia. We report a case of a 33-year-old female patient who was in an extraordinarily bad medical state, with severe hypercapnia (pCO2 15.1 kPa), sepsis, acute anuric kidney failure and resulting acidosis (pH 6.96). Her body mass index was 84 kg/m2. Her chances of survival were considered very low after failed attempts at noninvasive ventilation. Based on prior research, we refrained from intubation and chose venovenous extracorporeal membrane oxygenation to treat the hypercapnia. In the entire medical literature, we are not aware of a similarly extraordinary case of obesity-related hypoventilation syndrome that could finally be treated successfully. The idea behind this case report is to consider venovenous extracorporeal membrane oxygenation as an alternative to intubation in this patient collective.

References

  1. Vaquer S, de Haro C, Peruga P, Oliva JC, Artigas A. Systematic review and meta-analysis of complications and mortality of veno- venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome. Ann Intensive Care. 2017;7(1):51. doi:.https://doi.org/10.1186/s13613-017-0275-4 DOI: https://doi.org/10.1186/s13613-017-0275-4
  2. Swol J, Buchwald D, Strauch JT, Schildhauer TA, Ull C. Effect of body mass index on the outcome of surgical patients receiving extracorporeal devices (VV ECMO, pECLA) for respiratory failure. Int J Artif Organs. 2017;40(3):102–8. doi:.https://doi.org/10.5301/ijao.5000572 DOI: https://doi.org/10.5301/ijao.5000572
  3. Lazzeri C, Bonizzoli M, Cianchi G, Batacchi S, Terenzi P, Cozzolino M, et al. Body mass index and echocardiography in refractory ARDS treated with veno-venous extracorporeal membrane oxygenation. J Artif Organs. 2017;20(1):50–6. doi:.https://doi.org/10.1007/s10047-016-0931-8 DOI: https://doi.org/10.1007/s10047-016-0931-8
  4. Umei N, Ichiba S. Venovenous Extracorporeal Membrane Oxygenation as a Treatment for Obesity Hypoventilation Syndrome. Case Rep Crit Care. 2017;2017:9437452. doi:.https://doi.org/10.1155/2017/9437452 DOI: https://doi.org/10.1155/2017/9437452
  5. Kon ZN, Dahi S, Evans CF, Byrnes KA, Bittle GJ, Wehman B, et al. Class III Obesity is Not a Contraindication to Venovenous Extracorporeal Membrane Oxygenation Support. Ann Thorac Surg. 2015;100(5):1855–60. doi:.https://doi.org/10.1016/j.athoracsur.2015.05.072 DOI: https://doi.org/10.1016/j.athoracsur.2015.05.072
  6. Kadakia S, Ambur V, Moore R, Toyoda Y, Shiose A. Venovenous Extracorporeal Membrane Oxygenation in Two Morbidly Obese Patients. Gen Thorac Cardiovasc Surg. 2017;65(10):594–7. doi:.https://doi.org/10.1007/s11748-016-0740-2 DOI: https://doi.org/10.1007/s11748-016-0740-2

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