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J Thorac Cardiovasc Surg 2009;138:246-247
© 2009 The American Association for Thoracic Surgery

Brief Research Report

Combined use of extracorporeal membrane oxygenation and activated protein C for severe acute respiratory distress syndrome and septic shock

^a Division of Critical Care Medicine, Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
^b Division of Cardiac Surgery, Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada

Received for publication April 13, 2008; accepted for publication May 19, 2008.

^_* Address for reprints: Anson Cheung, MD, Division of Cardiac Surgery, St-Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 146. (Email: Acheung@provdencehealth.bc.ca).

The first 20% of the full text of this article appears below.

	Introduction

 
Several anticoagulation strategies are used in patients who receive extracorporeal membrane oxygenation (ECMO). We report 2 cases in which activated protein C (APC; Xigris; Eli–Lilly, Indianapolis, Ind) and ECMO were used concomitantly for severe refractory acute respiratory distress syndrome (ARDS) and septic shock. Both patients had a good outcome. Heparin-coated ECMO circuits and intravenous APC without other intravenous anticoagulants might represent a possible anticoagulation regimen in this patient population.

	Clinical Summary

 
Patient 1
The patient was a 60-year-old man hospitalized because of community-acquired pneumonia. On admission, he had severe hypoxemia (partial pressure of oxygen in arterial blood divided by inspired fraction of oxygen [PaO ₂/FIO ₂] = 95) and rapidly required endotracheal intubation, mechanical ventilation, broad-spectrum antibiotics, corticosteroids, and APC. Twenty-four hours later, he was transferred to a tertiary care facility to receive continuous renal replacement therapy for acute renal failure and management of septic shock. His oxygenation deteriorated (PaO ₂/FIO ₂ = 85) despite administration of 100% oxygen and high-frequency oscillation ventilation. The patient was started on venovenous ECMO. The right femoral vein and right internal jugular . . . [Full Text of this Article]

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