Case Study 1 A 9-year-old girl weighing

Case Study 1 A 9-year-old girl weighing 32 kg with a diagnosis of aplastic anemia was an inpatient on the oncology floor of a large pediatric hospital. She received a hematopoietic stem cell transplant. At that time, she developed an acute myocarditis that resulted in cardiorespiratory failure and began secondary chemotherapy using cyclosporine and cyclophosphamide. Vital signs are as follows: respiratory rate of 36 breaths per minute, heart rate of 130 beats per minute, and blood pressure of 90/55 mm Hg. She was subsequently transferred to the pediatric intensive care unit. Laboratory tests showed an increased N-terminal pro-B-type natriuretic peptide level of 10,000 pg/mL (normal, < 125 pg/mL) and hyperlactemia (4.2 mmol/L). Dobutamine was administered intravenously. A chest radiograph showed bilateral diffuse pulmonary infiltrates and pleural effusions. The hemodynamic state of the patient rapidly deteriorated with progressive hypotension (85/50 mm Hg), tachycardia (155 beats/min), and hyperlactemia (8.1 mmol/L) despite increasing doses of dobutamine. Arterial blood gas analysis revealed the following: pH 7.46, PaCO2 32 torr, PaO2 80 torr, HCO3 27.2, and base excess -1. The patient was intubated and mechanically ventilated. Echocardiography showed severe left ventricular hypokinesis with an ejection fraction of 30%. To support her worsening cardiorespiratory failure, she was placed on VA ECMO. 1. Explain the difference between VV ECMO and VA ECMO. 2. Why is VA ECMO indicated for the patient? 3. Describe one disadvantage of VA and VV ECMO SCIENCE HEALTH SCIENCE NURSING NURSING 154

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