Recovery from Fontan circulation failure by application of continuous negative extrathoracic pressure

J Anesth. 2007;21(2):282-4. doi: 10.1007/s00540-007-0497-y. Epub 2007 May 30.


A 2-year-old girl developed lethal circulatory failure, general edema, and hepatic dysfunction in an acute phase after total cavopulmonary connection, a Fontan-type operation. Application of continuous negative extrathoracic pressure (CNEP) with a cuirass ventilator at -4 cmH2O under spontaneous respiration dramatically improved hemodynamics, with systolic arterial pressure increasing from 82 mmHg to 90 mmHg, and central venous pressure decreasing from 15 mmHg to 13 mmHg; also, urine output increased, from 1.6 to 6.4 Improvements in hepatic function and fluid retention (reduction of pleural fluid and ascites) were also observed. The patient was successfully weaned from CNEP after 5 days. CNEP is an easily applicable, noninvasive tool to reduce pulmonary impedance, and is specifically useful to improve hemodynamics in patients after a Fontan-type operation. Our result suggests that CNEP may represent a first-line option to save patients from critical circulatory failure after a Fontan-type operation.

Publication types

  • Case Reports

MeSH terms

  • Child, Preschool
  • Decompression / methods*
  • Female
  • Fontan Procedure / adverse effects*
  • Humans
  • Shock / etiology*
  • Shock / therapy
  • Treatment Outcome