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Nishimura T, Hirata Y, Ise T, Iwano H, Izutani H, Kinugawa K, Kitai T, Ohno T, Ohtani T, Okumura T, Ono M, Satomi K, Shiose A, Toda K, Tsukamoto Y, Yamaguchi O, Fujino T, Hashimoto T, Higashi H, Higashino A, Kondo T, Kurobe H, Miyoshi T, Nakamoto K, Nakamura M, Saito T, Saku K, Shimada S, Sonoda H, Unai S, Ushijima T, Watanabe T, Yahagi K, Fukushima N, Inomata T, Kyo S, Minamino T, Minatoya K, Sakata Y, Sawa Y. JCS/JSCVS/JCC/CVIT 2023 Guideline Focused Update on Indication and Operation of PCPS/ECMO/IMPELLA. Circ J 2024; 88:1010-1046. [PMID: 38583962 DOI: 10.1253/circj.cj-23-0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Takashi Nishimura
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine
| | - Yasutaka Hirata
- Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | | | - Hironori Izutani
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine
| | | | - Takeshi Kitai
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center
| | - Takayuki Ohno
- Division of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo
| | - Kazuhiro Satomi
- Department of Cardiovascular Medicine, Tokyo Medical University Hospital
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University Hospital
| | - Koichi Toda
- Department of Thoracic and Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center
| | - Yasumasa Tsukamoto
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
| | - Takeo Fujino
- Department of Advanced Cardiopulmonary Failure, Faculty of Medical Sciences, Kyushu University
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
| | | | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hirotsugu Kurobe
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine
| | - Toru Miyoshi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
| | - Kei Nakamoto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Makiko Nakamura
- Second Department of Internal Medicine, University of Toyama
| | - Tetsuya Saito
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Keita Saku
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center
| | - Shogo Shimada
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | - Hiromichi Sonoda
- Department of Cardiovascular Surgery, Kyushu University Hospital
| | - Shinya Unai
- Department of Thoracic & Cardiovascular Surgery, Cleveland Clinic
| | - Tomoki Ushijima
- Department of Cardiovascular Surgery, Kyushu University Hospital
| | - Takuya Watanabe
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | | | | | - Takayuki Inomata
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Shunei Kyo
- Tokyo Metropolitan Institute for Geriatrics and Gerontology
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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Pires KD, Bloom J, Golob S, Sahagún BE, Greco AA, Chebolu E, Yang J, Ting P, Postelnicu R, Soetanto V, Joseph L, Bangalore S, Hall SF, Biary R, Hoffman RS, Park DS, Alviar CL, Harari R, Smith SW, Su MK. Successful Treatment of Confirmed Severe Bupropion Cardiotoxicity With Veno-Arterial Extracorporeal Membrane Oxygenation Initiation Prior to Cardiac Arrest. Cureus 2024; 16:e53768. [PMID: 38465186 PMCID: PMC10922220 DOI: 10.7759/cureus.53768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Bupropion is a substituted cathinone (β-keto amphetamine) norepinephrine/dopamine reuptake inhibitor andnoncompetitive nicotinic acetylcholine receptor antagonist that is frequently used to treat major depressive disorder. Bupropion overdose can cause neurotoxicity and cardiotoxicity, the latter of which is thought to be secondary to gap junction inhibition and ion channel blockade. We report a patient with a confirmed bupropion ingestion causing severe cardiotoxicity, for whom prophylactic veno-arterial extracorporeal membrane oxygenation (ECMO) was successfully implemented. The patient was placed on the ECMO circuit several hours before he experienced multiple episodes of hemodynamically unstable ventricular tachycardia, which were treated with multiple rounds of electrical defibrillation and terminated after administration of lidocaine. Despite a neurological examination notable for fixed and dilated pupils after ECMO cannulation, the patient completely recovered without neurological deficits. Multiple bupropion and hydroxybupropion concentrations were obtained and appear to correlate with electrocardiogram interval widening and toxicity.
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Affiliation(s)
- Kyle D Pires
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
- New York City Poison Center, New York City Department of Health and Mental Hygiene, New York, USA
| | - Joshua Bloom
- Division of Medical Toxicology, Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
- New York City Poison Center, New York City Department of Health and Mental Hygiene, New York, USA
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
| | - Stephanie Golob
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, USA
| | - Barbara E Sahagún
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
| | - Allison A Greco
- Division of Pulmonary, Critical Care, & Sleep Medicine, New York University Grossman School of Medicine, New York, USA
| | - Esha Chebolu
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
| | - Jenny Yang
- Department of Medicine, New York University Grossman School of Medicine, New York, USA
| | - Peter Ting
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, USA
| | - Radu Postelnicu
- Division of Pulmonary, Critical Care, & Sleep Medicine, New York University Grossman School of Medicine, New York, USA
| | - Vanessa Soetanto
- Division of Pulmonary, Critical Care, & Sleep Medicine, New York University Grossman School of Medicine, New York, USA
| | - Leian Joseph
- Division of Pulmonary, Critical Care, & Sleep Medicine, New York University Grossman School of Medicine, New York, USA
| | - Sripal Bangalore
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, USA
| | - Sylvie F Hall
- Cardiac Intensive Care Unit and Department of Pharmacy, Bellevue Hospital Center, New York, USA
| | - Rana Biary
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
- New York City Poison Center, New York City Department of Health and Mental Hygiene, New York, USA
| | - Robert S Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
- New York City Poison Center, New York City Department of Health and Mental Hygiene, New York, USA
| | - David S Park
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, USA
| | - Carlos L Alviar
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, USA
| | - Rafael Harari
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, USA
| | - Silas W Smith
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
- New York City Poison Center, New York City Department of Health and Mental Hygiene, New York, USA
| | - Mark K Su
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
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3
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Goumeniouk NL, Maclean DN, Howie JS, Waechter JE, Couillard P, Shaw JA, Lucyk SN. Stir Fry with a Side of Extracorporeal Membrane Oxygen: Management of Cardiogenic Shock Secondary to Unintentional Aconitine Ingestion. Wilderness Environ Med 2023; 34:567-570. [PMID: 37923684 DOI: 10.1016/j.wem.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/08/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023]
Abstract
Plant exposures leading to systemic or topical toxicity are common presentations seen in the emergency department. While often nonfatal, certain highly toxic plants result in cardiovascular or respiratory failure requiring invasive management. We describe a 65-y-old patient who presented with a refractory ventricular dysrhythmia secondary to an unintentional ingestion of an aconitine-containing plant after incorrect identification. Despite aggressive treatment with vasopressors, intravenous fluids, antiarrhythmics, as well as electrolyte correction and multiple attempted synchronized cardioversions, the patient remained in a refractory dysrhythmia with cardiogenic shock. Venoarterial extracorporeal membrane oxygen (ECMO) therapy was initiated successfully and resulted in rapid resolution of the unstable dysrhythmia. The patient was weaned from ECMO in under 48 h and was discharged without neurological or cardiovascular sequelae. This case highlights management options available to clinicians who encounter toxicity associated with aconitine ingestion. Fatal consequences were averted, and caution is required with the use of plant-identifying applications and resources.
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Affiliation(s)
| | - Davis N Maclean
- University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Joshua S Howie
- University of Saskatchewan, Department of Psychiatry, Regina, Saskatchewan
| | - Jason E Waechter
- University of Calgary, Department of Critical Care Medicine, Calgary, Alberta
| | - Philippe Couillard
- University of Calgary, Department of Critical Care Medicine, Calgary, Alberta
| | - Jeffrey A Shaw
- University of Calgary, Department of Cardiology, Calgary, Alberta
| | - Scott N Lucyk
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta; Poison and Drug Information Service (PADIS), Alberta Health Services, Calgary, Alberta
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4
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Akkaoui KK, Andersen LV, Nørgaard MA, Andreasen JB. Surviving cardiac arrest from severe metformin-associated lactic acidosis using extracorporeal membrane oxygenation and double continuous venovenous haemodialysis. BMJ Case Rep 2023; 16:e254649. [PMID: 37586755 PMCID: PMC10432636 DOI: 10.1136/bcr-2023-254649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Metformin-associated lactic acidosis (MALA) is a serious condition with high mortality. This case describes a man in the mid-60s with diabetes mellitus type 2 treated with metformin developing MALA 4 days after coronary stenting for non-ST-elevation myocardial infarction. He presented acutely with severe abdominal pain, a lactate of 19 mmol/L and pH 6.74. Despite treatment for MALA, he went into refractory cardiac arrest and was connected to venoarterial extracorporeal membrane oxygenation (VA-ECMO). He suffered a massive haemothorax due to perforation of the right atrial appendage. It was repaired through a sternotomy while being given massive blood transfusions. The following days, he was on VA-ECMO and double continuous venovenous haemodialysis (CVVHD). He survived with only mild paresis of the left hand. VA-ECMO should be considered a rescue therapy alongside treatment with CVVHD in case of cardiac arrest due to severe MALA.
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Zens T, Ochoa B, Eldredge RS, Molitor M. Pediatric venoarterial and venovenous ECMO. Semin Pediatr Surg 2023; 32:151327. [PMID: 37956593 DOI: 10.1016/j.sempedsurg.2023.151327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is an invaluable resource in the treatment of critically ill children with cardiopulmonary failure. To date, over 36,000 children have been placed on ECMO and the utilization of this life saving treatment continues to expand with advances in ECMO technology. This article offers a review of pediatric ECMO including modes and sites of ECMO cannulation, indications and contraindications, and cannulation techniques. Furthermore, it summarizes the basic principles of pediatric ECMO including circuit maintenance, nutritional support, and clinical decision making regarding weaning pediatric ECMO and decannulation. Finally, it gives an overview of common pediatric ECMO complications including overall mortality and long-term outcomes of ECMO survivors. The goal of this article is to provide a comprehensive review for healthcare professionals providing care for pediatric ECMO patients.
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Affiliation(s)
- Tiffany Zens
- Phoenix Children's Hospital, Department of Surgery, Divison of Pediatric Surgery, Phoenix, AZ, United States
| | - Brielle Ochoa
- Phoenix Children's Hospital, Department of Surgery, Divison of Pediatric Surgery, Phoenix, AZ, United States
| | - R Scott Eldredge
- Phoenix Children's Hospital, Department of Surgery, Divison of Pediatric Surgery, Phoenix, AZ, United States
| | - Mark Molitor
- Phoenix Children's Hospital, Department of Surgery, Divison of Pediatric Surgery, Phoenix, AZ, United States.
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Zhao CY, Sheng KJ, Bao T, Shi T, Liu PN, Yan Y, Zheng XL. Commercial and novel anticoagulant ECMO coatings: a review. J Mater Chem B 2023. [PMID: 37183615 DOI: 10.1039/d3tb00471f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is an invasive and last-resort treatment for circulatory and respiratory failure. Prolonged ECMO support can disrupt the coagulation and anticoagulation systems in a patient, leading to adverse consequences, such as bleeding and thrombosis. To address this problem, anticoagulation coatings have been developed for use in ECMO circuits. This article reviews commonly used commercial and novel anticoagulant coatings developed in recent years and proposes a new classification of coatings based on the current state. While commercial coatings have been used clinically for decades, this review focuses on comparing the effectiveness and stability of coatings to support clinical selections. Furthermore, novel anticoagulation coatings often involve complex mechanisms and elaborate design strategies, and this review summarises representative studies on mainstream anticoagulation coatings to provide a point of reference for future studies.
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Affiliation(s)
- Chang-Ying Zhao
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Kang-Jia Sheng
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Tao Bao
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Tao Shi
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Pei-Nan Liu
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Yang Yan
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Xing-Long Zheng
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
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Ng M, Wong ZY, Ponampalam R. Extracorporeal cardio-pulmonary resuscitation in poisoning: A scoping review article. Resusc Plus 2023; 13:100367. [PMID: 36860990 PMCID: PMC9969255 DOI: 10.1016/j.resplu.2023.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
Background Extracorporeal cardiopulmonary resuscitation (ECPR) represents last-line salvage therapy for poisoning-induced cardiac arrest but no review has focused on this specific area. Objective This scoping review sought to evaluate the survival outcomes and characteristics of published cases of ECPR for toxicological arrest, with the aim of highlighting the potential and limitations of ECPR in toxicology.Eligibility Criteria.We searched PubMed and Cochrane for eligible papers from database inception to October 1, 2022 using the keywords "toxicology", "ECLS" and "CPR". References of included publications were searched to identify additional relevant articles. Qualitative synthesis was used to summarize the evidence. Results 85 articles were chosen: 15 case series, 58 individual cases and 12 other publications that were analyzed separately due to ambiguity. ECPR may improve survival outcomes in selected poisoned patients, although the extent of benefit is unclear. As ECPR for poisoning-induced arrest may have better prognosis compared to from other aetiologies, it is likely reasonable to apply ELSO ECPR consensus guideline recommendations to toxicological arrest.Out-of-hospital cardiac arrest alone may not be sufficient grounds to deny ECPR if effective resuscitation had been promptly instituted. Poisonings involving membrane-stabilizing agents and cardio-depressive drugs, and cardiac arrests with shockable rhythms appear to have better outcomes. ECPR may permit excellent neurologically-intact recovery despite prolonged low-flow time of up to four hours. Early ECLS activation and pre-emptive catheter placement can significantly shorten time-to-ECPR and possibly improve survival. Conclusion As effects of poisoning may be reversible, ECPR can potentially support poisoned patients through the critical peri-arrest state.
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Affiliation(s)
- Mingwei Ng
- Corresponding author at: Department of Emergency Medicine, Singapore General Hospital, Outram Road, 169608, Singapore.
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Yusuke M, Hidetoshi Y, Yusuke T, Koji I, Masahito T, Susumu Y, Takayuki O. Intoxication with massive doses of amlodipine and candesartan requiring venoarterial extracorporeal membrane oxygenation. Acute Med Surg 2023; 10:e878. [PMID: 37533437 PMCID: PMC10392778 DOI: 10.1002/ams2.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023] Open
Abstract
Background Calcium channel blockers and angiotensin II receptor blockers are commonly prescribed to treat hypertension. Massive overdoses can cause both distributive and cardiogenic shock because of their effects on vascular smooth muscles and severe myocardial depression. Case Presentation We present the case of a 46-year-old man who was brought to our emergency department after ingesting 1210 mg amlodipine and 936 mg candesartan. The patient's hemodynamic status deteriorated despite treatment with vasopressors, calcium gluconate, and hyperinsulinemia-euglycemia therapy with mechanical ventilation. Venoarterial extracorporeal membrane oxygenation was initiated for refractory shock. The patient was weaned off extracorporeal membrane oxygenation on day 5 and discharged on day 18 of hospitalization. Conclusion When medical therapies are ineffective, aggressive venoarterial extracorporeal membrane oxygenation should be considered for the management of refractory shock in the setting of calcium channel blocker with angiotensin II receptor blocker overdose.
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Affiliation(s)
- Minagawa Yusuke
- Department of Emergency and Critical Care MedicineSaiseikai Utsunomiya HospitalUtsunomiyaJapan
| | - Yamana Hidetoshi
- Department of Emergency MedicineNational Hospital Organization Mito Medical CenterMitoJapan
| | - Tsutsumi Yusuke
- Department of Emergency MedicineNational Hospital Organization Mito Medical CenterMitoJapan
| | - Ishigami Koji
- Department of Emergency MedicineNational Hospital Organization Mito Medical CenterMitoJapan
| | - Togo Masahito
- Department of Emergency MedicineNational Hospital Organization Mito Medical CenterMitoJapan
| | - Yasuda Susumu
- Department of Emergency MedicineNational Hospital Organization Mito Medical CenterMitoJapan
| | - Ogura Takayuki
- Department of Emergency and Critical Care MedicineSaiseikai Utsunomiya HospitalUtsunomiyaJapan
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9
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Use of extracorporeal membrane oxygenation in massive amlodipine overdose. Arch Toxicol 2022; 96:3403-3405. [DOI: 10.1007/s00204-022-03364-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/11/2022] [Indexed: 11/02/2022]
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10
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Gottula AL, Neumar RW, Hsu CH. Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest - who, when, and where? Curr Opin Crit Care 2022; 28:276-283. [PMID: 35653248 DOI: 10.1097/mcc.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Extracorporeal cardiopulmonary resuscitation (ECPR) is an invasive and resource-intensive therapy used to care for patients with refractory cardiac arrest. In this review, we highlight considerations for the establishment of an ECPR system of care for patients suffering refractory out-of-hospital cardiac arrest (OHCA). RECENT FINDINGS ECPR has been shown to improve neurologically favorable outcomes in patients with refractory cardiac arrest in numerous studies, including a single randomized control trial. Successful ECPR programs are typically part of a comprehensive system of care that optimizes all phases of OHCA management. Given the resource-intensive and time-sensitive nature of ECPR, patient selection criteria, timing of ECPR, and location must be well defined. Many knowledge gaps remain within ECPR systems of care, postcardiac arrest management, and neuroprognostication strategies for ECPR patients. SUMMARY To be consistently successful, ECPR must be a part of a comprehensive OHCA system of care that optimizes all phases of cardiac arrest management. Future investigation is needed for the knowledge gaps that remain.
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Affiliation(s)
- Adam L Gottula
- Department of Emergency Medicine
- Department of Anesthesiology
| | - Robert W Neumar
- Department of Emergency Medicine
- Max Harry Weil Institute for Critical Care Research and Innovation
| | - Cindy H Hsu
- Department of Emergency Medicine
- Max Harry Weil Institute for Critical Care Research and Innovation
- Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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11
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Juneja D, Kataria S. Capillary leak syndrome: A rare cause of acute respiratory distress syndrome. World J Clin Cases 2022; 10:4324-4326. [PMID: 35665129 PMCID: PMC9131229 DOI: 10.12998/wjcc.v10.i13.4324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/05/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
Capillary leak syndrome (CLS) is a rare clinical syndrome associated with significant morbidity and mortality. Intensive care and supportive therapy constitute the mainstay of the treatment, along with judicious use of crystalloids and colloids such as dextran and starch during the leak phase. The advantages of proning, steroids, and intravenous immunoglobins are worth contemplating in patients with such a presentation. Extracorporeal membrane oxygenation appears to be an excellent strategy to surmount the impediments of the leak and post leak phase of CLS, especially in patients with severe or refractory hypoxemia.
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Affiliation(s)
- Deven Juneja
- Department ofCritical Care Medicine, Max Super Speciality Hospital, Delhi 110017, India
| | - Sahil Kataria
- Department ofCritical Care Medicine, Max Super Speciality Hospital, Delhi 110017, India
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12
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Parris MA, Calello DP. Found Down: Approach to the Patient with an Unknown Poisoning. Emerg Med Clin North Am 2022; 40:193-222. [DOI: 10.1016/j.emc.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Ives Tallman C, Zhang Y, Black N, Lynch K, Fayed M, Armenian P. Refractory vasodilatory shock secondary to metformin overdose supported with VA ECMO. Toxicol Rep 2022; 9:64-67. [PMID: 35004183 PMCID: PMC8718576 DOI: 10.1016/j.toxrep.2021.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 01/27/2023] Open
Abstract
Metformin overdose can lead to vasodilatory shock refractory to medical management. Extracorporeal circulatory support with venoarterial ECMO is an effective way to manage profound shock associated with metformin overdose. We report the highest recorded serum metformin level in the literature to date.
Metformin overdose may result in vasodilatory shock, lactic acidosis and death. Hemodialysis is an effective means of extracorporeal elimination, but may be insufficient in the shock setting. We present a case of a 39 yo male who presented with hypotension, coma, hypoglycemia, and lactate of 6.5 mmol/L after ingesting an unknown medication. Metformin overdose was suspected, and he was started on hemodialysis. He developed profound vasoplegia refractory to high doses of norepinephrine, vasopressin, epinephrine and phenylephrine. Venoarterial extracorporeal membrane oxygenation (VA ECMO) was initiated and he had full recovery. Serum analysis with high resolution liquid chromatography mass spectrometry revealed a metformin level of 678 μg/mL and trazodone level of 2.1 μg/mL. This case is one of only a handful of reported cases of metformin overdose requiring ECMO support, and we report the highest serum metformin levels in the literature to date. We recommend early aggressive hemodialysis and vasopressor support in all suspected cases of metformin toxicity as well as VA ECMO if refractory to these therapies. Objective We present a case of vasodilatory shock secondary to metformin overdose requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) support. This case is one of only a handful of reported cases of metformin overdose requiring ECMO support, and we report the highest serum metformin levels in the literature to date. Data sources University of San Francisco, Fresno. Study design Case report. Data extraction Clinical records and high resolution liquid chromatography mass spectroscopy analysis. Data synthesis None. Conclusions Venoarterial ECMO provided an effective means of hemodynamic support for a patient with severe metformin toxicity.
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Affiliation(s)
- Crystal Ives Tallman
- UCSF Fresno Department of Emergency Medicine, United States.,UCSF Fresno Department of Medicine, Pulmonary Critical Care Division, United States
| | - Yu Zhang
- UCSF Department of Laboratory Medicine, Division of Clinical Chemistry, San Francisco, CA, United States
| | - Nicholas Black
- UCSF Fresno Department of Emergency Medicine, United States
| | - Kara Lynch
- UCSF Department of Laboratory Medicine, Division of Clinical Chemistry, San Francisco, CA, United States
| | - Mohamed Fayed
- UCSF Fresno Department of Medicine, Pulmonary Critical Care Division, United States
| | - Patil Armenian
- UCSF Fresno Department of Emergency Medicine, United States
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14
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Park J. Serial blood concentration of polyethoxylated tallow amine and clinical presentations in acute herbicide poisoning. World J Emerg Med 2022; 13:305-308. [DOI: 10.5847/wjem.j.1920-8642.2022.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/20/2022] [Indexed: 11/19/2022] Open
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