Salvage Therapy with Non-Heparinized Extracorporeal Life Support for Massive Lung Hemorrhage after Pulmonary Thromboembolectomy

Salvage Therapy with Non-Heparinized Extracorporeal Life Support for Massive Lung Hemorrhage after Pulmonary Thromboembolectomy Muneaki Matsubara, Yuji Hiramatsu*, Tomohiro Imazuru*, Masataka Sato, Chiho Tokunaga, Mio Noma*, Tomoaki Jikuya* and Yuzuru Sakakibara* (Department of Cardiovascular Surgery, Tsukuba University Hospital, Tsukuba, Japan and Department of Surgery, Institute of Clinical Medicine, University of Tsukuba*, Tsukuba, Japan) Lung hemorrhage associated with pulmonary reperfusion injury is a rare but lethal condition. We presented a case salvaged by non-heparinized extracorporeal life support for massive lung hemorrhage after pulmonary thromboembolectomy. Sub-acute pulmonary thromboembolism with a floating right atrial thrombus was diagnosed in 63-year-old woman by computed tomography and echocardiography. An emergency pulmonary thromboembolectomy was performed using cardiopulmonary bypass and moderate hypothermia. Immediately after reperfusion, extraordinary lung hemorrhage occurred and continued. We decided to take over the standard cardiopulmonary bypass with a non-heparinized extracorporeal life support system. Fortunately, hemostasis of the lung hemorrhage was completely secured within 12h, and the extracorporeal life support was terminated at 20h after the surgery. The patient was extubated at 48h after the surgery, and was discharged after the insertion of an inferior vena cava filter for a floating deep venous thrombus. Although the necessity, efficacy and risk of the non-heparinized extracorporeal life support should be clarified, we conclude that it could be the treatment of choice for life threatening lung hemorrhage associated with pulmonary reperfusion injury. Jpn. J. Cardiovasc. Surg. 33: 359-362 (2004)