Avani Mohta, MD
Resident physician
Carle Foundation Hospital
Urbana, Illinois
Disclosure information not submitted.
Dakshinesh Paramesh, MD
MD
Carle Foundation Hospital
URBANA, Illinois, United States
Disclosure information not submitted.
Title: ECMO IN PATIENT WITH FAT EMBOLISM SYNDROME POST LIPOSUCTION SURGERY.
Case Report Body: INTRODUCTION :
Fat embolism syndrome (FES) is a rare, life-threatening complication of liposuction surgery. It presents as an intense inflammatory response leading to a multi-organ failure with a high mortality rate. Respiratory and neurological abnormalities are the expected initial presentation of FES. Treatment is limited to supportive care and lung-protective strategies. There have been case reports suggesting the use of ECMO in the management of ARDS secondary to FES. However, these case reports are few, limited to the use of VV-ECMO, and primarily described for patients with long-bone fractures.
CASE DESCRIPTION :
A 43-year-old female with a history of depression underwent right breast fibroadenoma removal with breast reconstruction and liposuction. Surgery was planned under Local anesthesia. At the time of fat injection, the patient suddenly became hypoxemic, requiring emergent intubation. She was diagnosed with acute respiratory distress syndrome secondary to FES.
The postoperative course was further complicated by distributive shock requiring vasopressor support. Due to worsening shock and hypoxemia on the ventilator despite lung-protective ventilation, VA ECMO was initiated. The patient was weaned off ECMO by day 5, and vasopressors were tapered off by day 8. She had a tracheostomy on day 15 and was discharged from the hospital on day 39 to a rehabilitation facility. Tracheostomy was eventually decannulated. At the time of discharge from the rehabilitation facility, she was on room air with no residual cognitive deficits and was independent of activities of daily living.
DISCUSSION :
To the best of our understanding, ours is the first case report that describes successful outcome using VA-ECMO for a patient with FES post liposuction surgery. Severe hypoxemia and refractory shock in our patient improved after initiation of the ECMO support for five days. ECMO should be considered in FES with severe hypoxemia and refractory shock.