Potential new treatment for inferior vena cava injury using extracorporeal membrane oxygenation applying flow diversion effect
Background Retrohepatic inferior vena cava (IVC) injuries remain among the most lethal and serious liver injuries. Gauze packing is currently the first choice for IVC injuries; however, laparotomy itself poses the risk of circulatory collapse. Thus, less invasive treatment strategies are needed.Meth...
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BMJ Publishing Group
2024-11-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/9/1/e001618.full |
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| author | Yasushi Asari Takaaki Maruhashi Keita Saku Hideo Maruki Marina Oi |
| author_facet | Yasushi Asari Takaaki Maruhashi Keita Saku Hideo Maruki Marina Oi |
| author_sort | Yasushi Asari |
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| description | Background Retrohepatic inferior vena cava (IVC) injuries remain among the most lethal and serious liver injuries. Gauze packing is currently the first choice for IVC injuries; however, laparotomy itself poses the risk of circulatory collapse. Thus, less invasive treatment strategies are needed.Methods In this study, we conducted an animal experiment to replicate and validate successful treatments for an actual case of retrohepatic IVC injury that we had encountered.Results A woman in her 80s presented to our hospital due to cardiac arrest caused by a pulmonary artery embolism. Venoarterial extracorporeal membrane oxygenation (ECMO) was introduced, and the patient was resuscitated. After resuscitation, contrast-enhanced CT revealed liver and retrohepatic IVC injuries, possibly caused by chest compressions. Liver injury was treated using transarterial embolization of the left hepatic artery. To treat the retrohepatic IVC injury, ECMO flow was increased to enhance the negative drainage pressure. The extravasation of the contrast medium had resolved in IVC angiography, and we opted for nonoperative management. The patient’s hemodynamic status gradually stabilized, and ECMO was withdrawn on day 6. We confirmed these findings in a dog model of retrohepatic IVC injury.Conclusions Our findings from the patient and the animal model suggest that the flow diversion effect of ECMO can effectively manage active bleeding from the IVC by inserting a drainage cannula across the injured lesion. We think this procedure represents a novel treatment option for retrohepatic IVC injuries. |
| format | Article |
| id | doaj-art-60b802c0f02740eba7ea92e61f57622e |
| institution | OA Journals |
| issn | 2397-5776 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMJ Publishing Group |
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| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-60b802c0f02740eba7ea92e61f57622e2025-08-20T02:32:39ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762024-11-019110.1136/tsaco-2024-001618Potential new treatment for inferior vena cava injury using extracorporeal membrane oxygenation applying flow diversion effectYasushi Asari0Takaaki Maruhashi1Keita Saku2Hideo Maruki3Marina Oi41Japanese Association for Acute Medicine, Emergency Task Force on the Fukushima Nuclear Power Plant Accident, Tokyo, JapanDepartment of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, JapanDepartment of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita, Osaka, JapanDepartment of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, JapanDepartment of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, JapanBackground Retrohepatic inferior vena cava (IVC) injuries remain among the most lethal and serious liver injuries. Gauze packing is currently the first choice for IVC injuries; however, laparotomy itself poses the risk of circulatory collapse. Thus, less invasive treatment strategies are needed.Methods In this study, we conducted an animal experiment to replicate and validate successful treatments for an actual case of retrohepatic IVC injury that we had encountered.Results A woman in her 80s presented to our hospital due to cardiac arrest caused by a pulmonary artery embolism. Venoarterial extracorporeal membrane oxygenation (ECMO) was introduced, and the patient was resuscitated. After resuscitation, contrast-enhanced CT revealed liver and retrohepatic IVC injuries, possibly caused by chest compressions. Liver injury was treated using transarterial embolization of the left hepatic artery. To treat the retrohepatic IVC injury, ECMO flow was increased to enhance the negative drainage pressure. The extravasation of the contrast medium had resolved in IVC angiography, and we opted for nonoperative management. The patient’s hemodynamic status gradually stabilized, and ECMO was withdrawn on day 6. We confirmed these findings in a dog model of retrohepatic IVC injury.Conclusions Our findings from the patient and the animal model suggest that the flow diversion effect of ECMO can effectively manage active bleeding from the IVC by inserting a drainage cannula across the injured lesion. We think this procedure represents a novel treatment option for retrohepatic IVC injuries.https://tsaco.bmj.com/content/9/1/e001618.full |
| spellingShingle | Yasushi Asari Takaaki Maruhashi Keita Saku Hideo Maruki Marina Oi Potential new treatment for inferior vena cava injury using extracorporeal membrane oxygenation applying flow diversion effect Trauma Surgery & Acute Care Open |
| title | Potential new treatment for inferior vena cava injury using extracorporeal membrane oxygenation applying flow diversion effect |
| title_full | Potential new treatment for inferior vena cava injury using extracorporeal membrane oxygenation applying flow diversion effect |
| title_fullStr | Potential new treatment for inferior vena cava injury using extracorporeal membrane oxygenation applying flow diversion effect |
| title_full_unstemmed | Potential new treatment for inferior vena cava injury using extracorporeal membrane oxygenation applying flow diversion effect |
| title_short | Potential new treatment for inferior vena cava injury using extracorporeal membrane oxygenation applying flow diversion effect |
| title_sort | potential new treatment for inferior vena cava injury using extracorporeal membrane oxygenation applying flow diversion effect |
| url | https://tsaco.bmj.com/content/9/1/e001618.full |
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