Page 35 - ANZCP Gazette APRIL 2022

were tested, including Vit D concentrations were all found to be normal. This unexplained elevated calcium levels were concluded to be secondary to prolonged bed rest and immobilisation. Heparin induced osteoclasts bone resorption was also thought to be a probable cause. Hypercalcaemia was treated with Calcitonin and normalised after 7 days.
On days 28 -30 of VV ECMO, haemolysis screen revealed signs of failing membrane due to an elevated D-dimers, lactate dehydrogenase, bilirubin, plasma free Hb with falling fibrinogen levels. Despite adequate SWEEP requirements, normal transmembrane pressures confirmed with pre and post membrane blood gases and minimal clots evident on the oxygenator, along with a prolonged ECMO support of 28 days that was reaching the manufacturers recommendation of use during support, with the uncertainty of remaining length of support during her treatment, the decision was reached for a membrane change-out and was conducted on day 30th uneventfully. This was scheduled during reasonable hours due to maximum staffing availability.
By day 38 on VV-ECMO support, our patient returned second negative for covid test and wean studies were commenced. The first wean study lasted one hour followed by a sudden cardiac
Photo 1 Photo 3
arrest of unclear cause. Further wean studies continued for 11 days before the final trial of decreased ECMO gas flow was con¬tinued for 27 hours with stable gas exchange prior to decannulation.
After 42 days on VV-ECMO, the patient was decannulated uneventfully. A surgical tracheostomy was performed after 4 days of ECMO decannulation, to facilitate ongoing pul- monary rehabilitation. She was then successfully weaned off ventilator.
By day 60 post-admission, 8 days post ECMO decannulation, she was alert, obeying commands and actively participating in her rehabilitation.
On days 61 -108 post admission, her tracheostomy decannulated one month post ventilator support, and was discharged from ICU on day 81 of her admission with ongoing medical and allied health reviews. (Photo 3)
She was discharged from the hospital on day 108 and returned in gratitude in December 2020, looking well (Photo 4).
Photo 2
Photo 4
*This is a requested reprint of a article published in the previous edition. The editor genuinely hopes that this version addresses the author’s grievance.
APRIL 2022 | www.anzcp.org 32