Santiago has had his primary problem repaired, but postoperatively developed ARDS without any known cause. The surgery went well, there was no hypotension, and he did not receive any blood products. But he clearly had severe hypoxemia and some acute inflammatory process affecting his lungs. He was placed on VV ECMO in the ICU with Femoral drainage and Right IJ return. His CXR on Day 1 of ECMO is below:

Fluid was removed starting ECMO day #2, and his lungs quickly improved. He was weaned and decannulated on ECMO day #4. Of note, he did have postoperative renal failure requiring CRRT, and as he awoke at the end of his ECMO course he had confusion and mental status changes prompting a MRI which demonstrated several small infarcts. It is certainly possible that he had some form of cholesterol emboli syndrome with cerebral and renal emboli, and a general systemic inflammatory response that caused or at least contributed to his ARDS. He received a tracheostomy and PEG, was weaned from the ventilator and transferred to a long- term care facility for rehabilitation therapy.