ECMO for intractable status asthmaticus following atracurium

Vittorio Scaravilli, Giacomo Grasselli, Annalisa Benini, Michela Bombino, Daniele Ceriani, Uta Emmig, Alberto Zanella, Nicolò Patroniti, Antonio Pesenti

Research output: Contribution to journalArticlepeer-review


Intraoperative allergic reactions are rare but serious events associated with increased morbidity and mortality. We report the salvage of intraoperative anaphylaxis leading to extreme hypercapnic respiratory failure by veno-venous extracorporeal membrane oxygenation (ECMO). A 38-year-old woman undergoing thyroidectomy developed intractable bronchospasm after administration of atracurium, leading to extreme hypercapnic respiratory failure (PaCO2 > 250 mmHg, pH 6.773). After the failure of conventional medical therapy and ventilatory optimization, the patient was connected to a veno-venous ECMO circuit. PaCO2 of 45.6 mmHg and pH of 7.25 were achieved in 1 h, by slowly increasing sweep gas flows up to 3.5 L/min and using continuous end-tidal CO2 monitoring to gauge the procedure. After extubation and disconnection from ECMO, the patient was discharged on the 6th day without sequelae. Rapid reversal of extreme hypercapnic acidosis by ECMO was feasible, without any neurologic sequelae. Veno-venous ECMO support may be a valuable option for the salvage of intraoperative anaphylaxis.

Original languageEnglish
Pages (from-to)178-181
Number of pages4
JournalJournal of Artificial Organs
Issue number2
Publication statusPublished - 2017


  • Anaphylaxis
  • Bronchial spasm
  • Extracorporeal membrane oxygenation
  • Hypercapnia
  • Respiratory insufficiency

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Biomaterials
  • Biomedical Engineering
  • Cardiology and Cardiovascular Medicine


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