The Emergent Use of Cardiopulmonary Bypass and Extracorporeal Membrane Oxygenator in a Child with Sickle Cell Disease
INTRODUCTION: The use of cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenator (ECMO) in patients suffering from sickle cell disease (SCD) needs specific precautions. Whereas, no consensual protocols have been established to clarify therapeutic management.
CASE REPORT: A 7-year-old boy was admitted to the hospital for surgery of advanced endocarditis. Major dyspnea, hemodynamic distress and fever were noted on physical examination. Biological tests exploring anaemia revealed haemoglobin (Hb) S levels of 39.1%. Echocardiography showed important right heart cavities dilation with multiple aortic vegetations. The child was accepted for emergent surgery. Ten minutes after anesthetic induction, serious hemodynamic distress was established. The patient was put on normothermic CPB when he received four packed red-blood-cell. After surgery, he was placed on ECMO support for 2 days than he succumbed.
CONCLUSION: Urgent cardiac surgery in patients suffering from SCD poses a major therapeutic dilemma. Multiplying case reports and encouraging prospective studies are necessary to define the right place of cardio-pulmonary assistance in treatment protocols for better management.
