Veno-venous-extracorporeal membrane oxygenation treatment for severe capillary leakage syndrome: A case report

BACKGROUND Capillary leak syndrome(CLS)is characterized by the leakage of large amounts of fluid and plasma proteins into the interstitial space,resulting in hypoalbuminemia,hypovolemic shock,elevated blood concentration,systemic progressive edema,and multiple serosal cavity effusion.Clinical syndromes such as cavity effusion pose a grave threat to the life and health of the patient.CASE SUMMARY A 58-year-old female patient was admitted to the hospital after being in a coma for 6 h following accidental ingestion of a pesticide.She was treated with phencyclidine hydrochloride and pralidoxime iodide for detoxification,mechanical ventilation to maintain oxygen supply,continuous renal replacement therapy to maintain the internal environment,and hemoperfusion to promote the excretion of toxins.She also received a transfusion of red blood cells and massive fluid resuscitation.However,her blood pressure was not maintained.The patient was diagnosed with CLS due to pesticide poisoning.Oxygenation was difficult to maintain under full ventilator support;therefore,veno-venous-extracorporeal membrane oxygenation(VV-ECMO)treatment was given 13 h after admission.Her oxygenation level improved,but a large amount of ascites and pleural effusion soon became apparent.We continued drainage with an indwelling drainage tube,and the ECMO flow stabilized.The leakage gradually decreased,and ECMO was discontinued 3 d later.On the 6th day,the patient recovered from unconsciousness,but on gastroscopic evaluation,severe erosions were found in her entire stomach.With the family’s consent,treatment was stopped,and the patient was discharged from the hospital on the 7th day.CONCLUSION ECMO,liquid resuscitation and management,and improvement in plasma colloidal osmotic pressure,circulation,and tissue oxygen supply are crucial in treating CLS.

Establishment of a Rat Model of Capillary Leakage Syndrome Induced by Cardiopulmonary Resuscitation After Cardiac Arrest

Objective:Cardiopulmonary resuscitation(CPR)after cardiac arrest(CA)is one of the main causes of capillary leakage syndrome(CLS).This study aimed to establish a stable CLS model following the CA and cardiopulmonary resuscitation(CA-CPR)model in Sprague-Dawley(SD)rats.Methods:We conducted a prospective,randomized,animal model study.All adult male SD rats were randomly divided into a normal group(group N),a sham operation group(group S),and a cardiopulmonary resuscitation group(group T).The SD rats of the three groups were all inserted with 24-G needles through their left femoral arteries and right femoral veins.In group S and group T,the endotracheal tube was intubated.In group T,CA induced by asphyxia(AACA)was caused by vecuronium bromide with the endotracheal tube obstructed for 8 min,and the rats were resuscitated with manual chest compression and mechanical ventilation.Preresuscitation and postresuscitation measurements,including basic vital signs(BVS),blood gas analysis(BG),routine complete blood count(CBC),wet-to-dry ratio of tissues(W/D),and the HE staining results after 6 h were evaluated.Results:In group T,the success rate of the CA-CPR model was 60%(18/30),and CLS occurred in 26.6%(8/30)of the rats.There were no significant differences in the baseline characteristics,including BVS,BG,and CBC,among the three groups(P>0.05).Compared with pre-asphyxia,there were significant differences in BVS,CBC,and BG,including temperature,oxygen saturation(SpO_(2)),mean arterial pressure(MAP),central venous pressure(CVP),white blood cell count(WBC),hemoglobin,hematocrit,pH,pCO_(2),pO_(2),SO_(2),lactate(Lac),base excess(BE),and Na+(P<0.05)after the return of spontaneous circulation(ROSC)in group T.At 6 h after ROSC in group T and at 6 h after surgery in groups N and S,there were significant differences in temperature,heart rate(HR),respiratory rate(RR),SpO_(2),MAP,CVP,WBC,pH,pCO_(2),Na+,and K+among the three groups(P<0.05).Compared with the other two groups,the rats in group T showed a significantly increased W/D weight ratio(P<0.05).The HE-stained sections showed consistent severe lesions in the lung,small intestine,and brain tissues of the rats at 6 h after ROSC following AACA.Conclusion:The CA-CPR model in SD rats induced by asphyxia could reproduce CLS with good stability and reproducibility.