TY - JOUR T1 - Pre-emptive ECMO cannulation in a patient with severe pulmonary hypertension and acute appendicitis undergoing appendectomy JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2020-000610 VL - 5 IS - 1 SP - e000610 AU - Mahnoor Zia AU - Jose Muniz Castro AU - Hina Faisal AU - Daniel J Bonville Y1 - 2020/11/01 UR - http://tsaco.bmj.com/content/5/1/e000610.abstract N2 - A 30-year-old woman presented with a 2-day history of abdominal pain, nausea, vomiting and fever. She had a medical history of severe pulmonary hypertension, bilateral pulmonary emboli, right heart failure, hypothyroidism and systemic hypertension. She was classified as World Health Organization (WHO) functional class III for pulmonary hypertension. Physical examination was remarkable for tenderness to palpation over the right lower quadrant without rebound. Laboratory evaluation revealed leukocytosis (18.3 k/µL) with left shift (82.5% neutrophils). CT scan of the abdomen and pelvis was remarkable for distended fluid-filled appendix, with small appendicoliths and surrounding edema (figure 1). The patient was transferred to our facility for a higher level of care requiring cardiopulmonary evaluation and optimization before possible appendectomy. At the time of transfer, she had developed respiratory distress and was admitted directly to the intensive care unit. A right heart catheterization revealed severe pulmonary hypertension with a right ventricular systolic pressure of 120 mm Hg and moderate to severe tricuspid regurgitation. The patient was at high risk for right ventricular failure and pulmonary hypertensive crisis. The initial aim was to optimize medical condition of the patient with the hope to avoid operative … ER -