Abstract:

Methods The clinical data of one patient with cardiogenic shock complicated with hypoxemia treated with ECMO and IABP were collected， the etiology and treatment method of hypoxemia were analyzed， and the related literatures were reviewed. Results The patient，48-year-old male， was hospitalized because of paroxysmal precordial pain for 1 d and exacerbation for 4 h. The coronary angiography was performed 1 h after hospitalization，and the proximal anterior descending branch occlusion was found，and the anterior descending branch stent was implanted. The patients’s intraoperative blood pressure was 92/60 mmHg and the heart rate was 110 min^－1， and the IABP （1∶1 counterpulsation） was installed. The heart failure occurred in the patient on the second day after operation，and the patient failed the routine cardiotonic and diuretic treatments and was transferred to Intensive Care Unit （ICU） Department for the ECMO support. On the second day of ECMO support， the patient had a sudden aggravation in the circulation and respiration （the heart rate was raised up to 150－160 min^－1，the blood pressure was dropped to 98/79 mmHg，the respiratory rate was increased to 35 min^－1）， and the percutaneous arterial oxygen saturation （SpO₂） was dropped to 89%. The bedside ultrasound examination results showed that and there was a weak motivation of ventricular of heart and the left ventricle was full.After investigation， it was considered to be caused by membranous pulmonary edema and high frequency of the IABP counterpulsation. The oxygenation state was obviously improved after optimizing the mechanical ventilation setting，the ECMO sweep flow was switched to 10 L·min^－1， and a mass of water droplets were discharged from the membrane exhaust hole；after the IABP counterpulsation frequency was set as 1∶2， the patient’s condition was significantly relieved； finally the ECMO and IABP were successfully removed， and the patient recovered and was discharged from hospital. Conclusion The non-alarm malfunction and improper setting of the extracorporeal equipment can lead to the decreasing of the support performance and aggravation of the disease； when the abnormity occurs， the essential vital signs of the patient should be maintained， then the malfunctions of the equipment should be checked quickly. Objective To analyze the clinical manifestations and treatment method of hypoxemia patients treated with of extracorporeal membrane oxygenation （ECMO） combined with aortic balloon pump （IABP），and to improve the management， identification and analysis abilities of the clinicians for hypoxemia during the treatment of ECMO combined with IABP.

Key words: Cardiogenic shock, Extracorporeal membrane oxygenation, Intra-aortic balloon pump, Membrane edema, Hypoxemia