Authors
- Marijan Pašalić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-3197-2190
- Boško Skorić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-5979-2346
- Maja Čikeš — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-4772-5549
- Daniel Lovrić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-5052-6559
- Jana Ljubas Maček — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-7171-2206
- Hrvoje Jurin — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-2599-553X
- Jure Samardžić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-9346-6402
- Joško Bulum — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-1482-6503
- Davor Miličić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-9101-1570
Keywords
venovenous extracorporeal membrane oxygenation, drowning, acute respiratory distress syndrome
DOI
https://doi.org/10.15836/ccar2018.51Full Text
**Introduction**: Benefits of venovenous extracorporeal membrane oxygenation (VV-ECMO) in patients with severe acute respiratory failure (RF) have been identified in different trials (1). Due to surfactant washout, drowning often results in acute respiratory distress syndrome (ARDS), which remains the most important cause of death in those patients surviving the transfer to hospital. **Case report**: 32-year-old male patient with no prior medical history presented to our Emergency Department following drowning and a successful resuscitation. He was found submerged in the pool just a couple of minutes after being seen conscious and swimming. Lifeguard on duty pulled him out of the pool and started cardiopulmonary resuscitation. Upon the arrival of Emergency Medical Service, patient had a pulse and was breathing spontaneously, but was exhibiting grand mal seizures and not recovering consciousness. In the emergency department he was put on mechanical ventilation (MV) due to global RF and in the Coronary Care Unit therapeutic hypothermia (TH) was started. Urgent diagnostics was performed and no signs of stroke, coronary artery disease, pulmonary embolism or significant electrolyte imbalance were detected. 12-lead ECG and echocardiography showed no abnormal findings despite severe respiratory acidosis. Due to signs of ARDS (**Figure 1**) and worsening RF in spite of increasing MV support, VV ECMO implantation was indicated. It was successfully conducted in the early period (th day) and of MV (8th day). He exhibited no signs of neurologic deficit and was rapidly mobilized. Finally, on the 21st day he was discharged home. FIGURE 1. MSCT findings showing diffuse pulmonary (parenchimal) infiltrates and radiologic signs of acute respiratory distress syndrome. FIGURE 2. X-ray findings before and after methylprednisolone and cefepime therapy. **Conclusion**: Our case report recognizes the potential life-saving role of VV-ECMO in treating drowning patients with severe ARDS. Hence, the use of ECMO should be beared in mind as a treatment modality in all drowning victims.
Literature
- Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. CESAR trial collaboration. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009 Oct 17;374(9698):1351–63. https://doi.org/10.1016/S0140-6736(09)61069-2
