Key result
Immediate treatment with VV-ECMO and aggressive fluid replacement successfully resolved fulminating non-cardiogenic pulmonary edema by post-operative day 2 in two patients following cardiac surgery.
Why the study?
A malignant form of non-cardiogenic pulmonary edema developing soon after cardiopulmonary bypass termination during cardiac surgery is rare and can cause lethal respiratory failure requiring immediate management.
Does VV-ECMO and aggressive fluid replacement improve clinical outcomes in patients with fulminating non-cardiogenic pulmonary edema following cardiac surgery?
Case Report (n=2)
Does VV-ECMO and aggressive fluid replacement improve clinical outcomes in patients with fulminating non-cardiogenic pulmonary edema following cardiac surgery?
Immediate treatment with VV-ECMO and aggressive fluid replacement can successfully manage transient, fulminating non-cardiogenic pulmonary edema following cardiac surgery.
May support VV-ECMO with fluid resuscitation for post-cardiac surgery edema; hypothesis-generating and requires prospective validation.
A malignant form of non-cardiogenic pulmonary edema (NCPE) that develops soon after the termination of cardiopulmonary bypass support during cardiac surgery is rarely encountered. It sometimes requires immediate management, including venovenous extracorporeal membrane oxygenation (VV-ECMO). In the first case, a 78-year-old female patient experienced fulminating NCPE after mitral valve plasty, which caused severe respiratory failure and hemodynamic instability due to a huge amount of sputum. In the second case, a 47-year-old male patient presented with right-sided unilateral pulmonary edema with a substantial amount of sputum after minimally invasive cardiac surgery for mitral valve repair. In both cases, VV-ECMO and aggressive fluid replacement were promptly initiated. The NCPE resolved on post-operative day 2, resulting in the successful termination of VV-ECMO. NCPE leads to lethal respiratory failure with multifactorial causes during cardiac surgery. However, as NCPE is potentially transient, immediate treatment comprising VV-ECMO and aggressive fluid replacement can improve clinical outcomes.
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Arima et al. (2023) conducted a case report in Fulminating non-cardiogenic pulmonary edema (NCPE) following cardiac surgery (n=2). Venovenous extracorporeal membrane oxygenation (VV-ECMO) and aggressive fluid replacement was evaluated on Resolution of NCPE and successful termination of VV-ECMO. Immediate treatment with VV-ECMO and aggressive fluid replacement successfully resolved fulminating non-cardiogenic pulmonary edema by post-operative day 2 in two patients following cardiac surgery.
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