小児外傷性肺損傷に対してECMOを用いて救命し得た1経験例(Successful use of extracorporeal membrane oxygenation in a pediatric trauma patient with acute lung failure: a case report)

要旨 重症呼吸不全に対するextracorporeal membrane oxygenation（ECMO）の適用は普及しつつある。しかし，多発外傷に対しては出血の問題があり，その適応は確立されていない。今回我々は，小児外傷後肺損傷に対し，ECMOを用いて救命した1例を報告する。症例は5歳，男児。乗用車に轢過され救急搬送された。血気胸，肺損傷，肝損傷，骨盤骨折，大腿骨骨折が認められた。止血処置を行った後，人工呼吸器管理では対応できない呼吸不全に陥ったため，veno–venous ECMO（VV–ECMO）を導入した。ヘパリンコーティングされた回路を用い，抗凝固療法としてメシル酸ナファモスタットを用いた。次第に呼吸状態は改善し，合併症を来すことなく導入から92時間後に離脱した。人工呼吸器管理では対応しきれない小児外傷性肺損傷に対してECMOは有効と考えられる。 ABSTRACT Extracorporeal membrane oxygenation (ECMO) is a therapeutic modality that can provide cardiorespiratory support, while allowing lung rest for patients with acute respiratory failure. However, using ECMO for patients with severe trauma with preexisting bleeding shock is still unusual because of the hemorrhagic complications associated with systemic heparinization. We report a pediatric patient with post–traumatic lung injury treated by ECMO. A 5–year–old boy was seriously injured in a motor vehicle accident and transferred to our hospital. He was diagnosed with hemopneumothorax, lung injury, liver injury, pelvic fracture and femur fracture. He required admission to intensive care because of severe hypoxia. Despite receiving maximum ventilatory support, he demonstrated severe respiratory failure. Hence, on the second day, he was treated with ECMO with a heparin–free circuit. Nafamostat mesilate was used as an anticoagulant on the third day. Following these measures, his respiratory status improved and ECMO was successfully discontinued after 92 hours, without major bleeding. We conclude that VV–ECMO can be a safe and highly effective rescue treatment in pediatric trauma patients with resistant pulmonary failure.