Abdominal compartment syndrome contributing to failure of extracorporeal membrane oxygenation in an infant with congenital heart disease and sepsis

Objective: To provide the first account of extracorporeal membrane oxygenation therapy failure secondary to abdominal compartment syndrome. Design: Case report. Setting: Pediatric intensive care unit. Patient: A 4-month-old infant with cyanotic congenital heart disease and Escherichia coli sepsis developed abdominal distention and venous return failure on extracorporeal membrane oxygenation. Intervention: Emergency cardiac catheterization and atrial septectomy were performed. Main Results: Central venous pressure of 120 mm Hg was measured, confirming the diagnosis of abdominal compartment syndrome. Conclusions: Abdominal compartment syndrome is a life-threatening condition resulting from an increase in intraabdominal pressure that compromises abdominal organ perfusion, pulmonary function, and cardiac output. Mortality rates from abdominal compartment syndrome are as high as 60% in adults and children. This report of an infant with congenital heart disease and E coli sepsis represents the first description of abdominal compartment syndrome that contributed to failure of extracorporeal membrane oxygenation and ultimately death. The pathophysiology, diagnosis, and treatment of abdominal compartment syndrome are also reviewed.