Acute respiratory distress syndrome (ARDS) is difficult to treat and it is often fatal. If the medical treatment for ARDS is not effective, then extracorporeal membrane oxygenation (ECMO) can be applied to the patient. A 22-year-old female who suffered multiple traumatic injuries due to a car accident presented with acute respiratory distress syndrome. Veinarterial extracorporeal membrane oxygenation (VA ECMO) was started to treat her respiratory failure. With the VA ECMO, the systemic oxygen

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... turation remained at only 84%, and so the ECMO system was switched to V-VA ECMO via an additional venous outflow through the right jugular vein to increase both the systemic and pulmonary oxygen saturation. After conversion to the V-VA type ECMO, the systemic oxygen saturation increased to 94% and the partial pressure of oxygen (PaO 2 ) increased to 65 mmHg. We report here on a successful case of ECMO conversion from the VA type to the V-VA type in a patient with severely hypoxic respiratory failure. (Korean J Thorac Cardiovasc Surg 2010;43:104-107) Key words: 1. Acute respiratory distress syndrome (ARDS) 2. Multiple trauma 3. Extracorporeal membrane oxygenation 증 례 21세 여자가 외상성 안면부 골절에 대해 개방성 내고정 술을 시행 받고나서 발생한 호흡곤란 및 단순흉부 X선 소 견의 악화로 기관삽관 상태로 전원되었다. 환자는 전원 3 일전 교통사고로 인해 다발성 늑골 골절, 혈흉, 골반뼈 골 절, 좌측 관골구 골절, 천골 골절, 좌측 경골 골절, 좌측 안 와 골절, 좌측 광대뼈 및 위턱뼈 골절 진단받았다. 중환자 실에서 기계적 환기를 시행하였으며 보조조절방식(assistcontrolled mode), 압력조절방식(pressure-controlled mode) 20 ∼25 cmH2O, 일회호흡량 500∼600 mL, 분당호흡수 16회, 흡입산소농도 0.9∼1.0, 호기말양압 8∼10 cmH2O에서 동 맥혈가스분석(ABGA)는 pH 7.51, PCO2 32.6 mmHg, PO2 43.3 mmHg, 산소포화도 83.5%였고 단순흉부촬영에서 양 이성준 외 정맥-정맥동맥 체외막 산화기(Veno-venoarterial ECMO) − 105 −