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emergency department ecmo

Joseph E Tonna, Craig H Selzman, Michael P Mallin, Brigham R Smith, Scott T Youngquist, Antigoni Koliopoulou, Frederick Welt, Kathleen Diane Stoddard, Ram Nirula, Richard Barton, James Franklin Fair, James C Fang, Stephen McKellar
Despite advances in the medical and surgical management of cardiovascular disease, greater than 350,000 patients experience out-of-hospital cardiac arrest in the United States annually, with only a 12% neurologically favorable survival rate. Of these patients, 23% have an initial shockable rhythm of ventricular fibrillation/pulseless ventricular tachycardia (VF/VT), a marker of high probability of acute coronary ischemia (80%) as the precipitating factor. However, few patients (22%) will experience return of spontaneous circulation and sufficient hemodynamic stability to undergo cardiac catheterization and revascularization...
January 27, 2017: Annals of Emergency Medicine
Steven A Conrad, Peter T Rycus
Extracorporeal cardiopulmonary resuscitation (ECPR) is the use of rapid deployment venoarterial (VA) extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR). Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates...
January 2017: Annals of Cardiac Anaesthesia
Wei-Cheng Chen, Kuo-Yang Huang, Chih-Wei Yao, Cing-Feng Wu, Shinn-Jye Liang, Chia-Hsiang Li, Chih-Yeh Tu, Hung-Jen Chen
BACKGROUND: Although many risk models have been tested in patients who undergo extracorporeal membrane oxygenation, few have been assessed for patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support in the emergency department (ED). This study aimed to successfully predict outcomes of patients with cardiac or noncardiac failure who received VA-ECMO in the ED within 24 hours of arrival at the ED. METHOD: This retrospective, observational cohort study included 154 patients, who were classified as cardiac (n = 127) and noncardiac (n = 27) patients and received VA-ECMO within 24 hours after arrival at the China Medical University Hospital ED in Taiwan between January 2009 and September 2014...
October 22, 2016: Critical Care: the Official Journal of the Critical Care Forum
Joseph E Tonna, Nicholas J Johnson, John Greenwood, David F Gaieski, Zachary Shinar, Joseph M Bellezo, Lance Becker, Atman P Shah, Scott T Youngquist, Michael P Mallin, James Franklin Fair, Kyle J Gunnerson, Cindy Weng, Stephen McKellar
PURPOSE: To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department. METHODS: We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO)...
October 2016: Resuscitation
Thomas Pasgaard, Anh-Nhi Thi Huynh, Jakob Gjedsted
We present a rare cause of acute respiratory distress syndrome (ARDS) due to an accidental intravascular injection of paraffin oil. While there is no specific therapy, we decided to support the patient with veno-venous extracorporeal membrane oxygenation (V-V ECMO) to allow the ARDS to resolve. A previously healthy 30-year-old man was admitted to the Emergency Department with acute onset respiratory distress following an injection with paraffin oil for cosmetic purposes. In 36 hours, the patient developed severe ARDS and respiratory support with V-V ECMO was initiated...
May 13, 2016: Perfusion
Taro Imaeda, Taka-Aki Nakada, Ryuzo Abe, Yoshihisa Tateishi, Shigeto Oda
Streptococcal toxic shock syndrome (STSS), an invasive Streptococcus pyogenes (Group A streptococcus) infection with hypotension and multiple organ failure, is quite rare in pregnancy but is characterized by rapid disease progression and high fatality rates. We present a case of STSS with infection-induced cardiac dysfunction in a pregnant woman who was treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). A 24-year-old multiparous woman in the third trimester had early symptoms of high fever and diarrhea 1 day prior to admission to the hospital emergency department...
June 2016: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Jarrod M Mosier, Melissa Kelsey, Yuval Raz, Kyle J Gunnerson, Robyn Meyer, Cameron D Hypes, Josh Malo, Sage P Whitmore, Daniel W Spaite
Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that augments oxygenation, ventilation and/or cardiac output via cannulae connected to a circuit that pumps blood through an oxygenator and back into the patient. ECMO has been used for decades to support cardiopulmonary disease refractory to conventional therapy. While not robust, there are promising data for the use of ECMO in acute hypoxemic respiratory failure, cardiac arrest, and cardiogenic shock and the potential indications for ECMO continue to increase...
December 17, 2015: Critical Care: the Official Journal of the Critical Care Forum
Alon Nevet, Talia Polak, Ovdi Dagan, Yehezkel Waisman
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) may serve as a bridge to regain cardiac function in refractory resuscitation. However, its use has so far been limited owing to low availability, especially in emergency departments. OBJECTIVES: To describe two children with acute myocarditis successfully treated with ECMO in the emergency department of a tertiary pediatric medical center. DESCRIPTION: The children presented with vomiting, followed by rapid deterioration to cardiogenic shock that failed to respond to conservative treatment...
October 2015: Israel Medical Association Journal: IMAJ
Matthias Weuster, Assad Haneya, Bernd Panholzer, Tim Klüter, Michael van der Brelie, Ulrich van Laak, Jochen Cremer, Nils Haake
Cardiopulmonary failure because of drowning with accidental hypothermia (AH) remains a major task for emergency care physicians. In this case series, we describe our experience in nine patients with cardiopulmonary failure after drowning with AH less than 35°C, who were provided on an emergency basis with extracorporeal life support (ECLS) system or extracorporeal membrane oxygenation (ECMO). Conservative rewarming methods are not considered for this study. Preclinical conditions and protocols were gathered...
March 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Kao-Ping Chua, Mark I Neuman, J Michael McWilliams, Paul L Aronson
OBJECTIVE: To describe the association between clinical outcomes and clinical practice guidelines (CPGs) recommending universal cerebrospinal fluid (CSF) testing in the emergency department for febrile infants aged 29-56 days. STUDY DESIGN: Using 2007-2013 administrative data from 32 US children's hospitals, we performed a difference-in-differences analysis comparing 7 hospitals with CPGs recommending universal CSF testing for older febrile infants aged 29-56 days (CPG group) with 25 hospitals without such CPGs (control group)...
December 2015: Journal of Pediatrics
Cheng-Wei Chan, I-Lin Wu, Ching-Hsing Lee, Shou-Chien Hsu, Shu-Chen Liao
OBJECTIVE: To describe the experience of emergency extracorporeal membrane oxygenation in treating life-threatening glyphosate-surfactant intoxication. DESIGN: Case report. SETTING: Emergency department and ICU. PATIENT: A patient with cardiopulmonary failure after glyphosate-surfactant intoxication. INTERVENTION: Extracorporeal membrane oxygenation. CASE REPORT: A 47-year-old man presented with mildly decreased consciousness in our emergency department after ingesting approximately 100 mL of glyphosate-surfactant 1...
January 2016: Critical Care Medicine
George V Patrut, Claudiu Neamtu, Mihai Ionac
INTRODUCTION: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO(1)) systems are a life-saving option in the treatment of acute respiratory distress syndrome (ARDS(2)), but may be encumbered by severe vascular complications in the groin. PRESENTATION OF CASE: A pregnant woman was admitted with respiratory failure due to H1N1 influenza. VA-ECMO was inserted percutaneously by the intensivists and then accidentally removed by the patient after 8 days. 24h later VA-ECMO was reinstalled with surgical denudation of femoral vessels in another department...
2015: International Journal of Surgery Case Reports
Ananya Vashisht, Narmada Katakam, Samina Kausar, Neena Patel, Jane Stratton
A 30-year-old primigravida with no known comorbidities presented to the emergency department at 29+6/40 gestation, with breathlessness. The initial diagnosis was pulmonary embolism, which was later revised following initial investigations and considered to be pre-eclampsia/HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. Following caesarean section and delivery of a live baby, the patient had episodes of cyanotic hypoxia and was admitted to intensive care. A provisional diagnosis of idiopathic pulmonary hypertension was performed...
September 14, 2015: BMJ Case Reports
Susan R Wilcox, Christopher Kabrhel, Richard N Channick
Pulmonary hypertension is a hemodynamic condition, defined as a mean pulmonary artery pressure by right-sided heart catheterization of at least 25 mm Hg at rest. It is classified into 5 general groups based on the underlying cause, with left ventricular failure and chronic obstructive pulmonary disease being 2 of the most common causes in the United States. Although the specifics of the pathophysiology will vary with the cause, appreciating the risks of pulmonary hypertension and right ventricular failure is critical to appropriately evaluating and resuscitating pulmonary hypertension patients in the emergency department (ED)...
December 2015: Annals of Emergency Medicine
Joshua C Reynolds, Bryan S Judge
Flecainide is a class Ic antidysrhythmic agent used to prevent and treat tachydysrhythmias. Flecainide toxicity primarily causes cardiovascular and neurologic effects through sodium-channel blockade. There is scant evidence to support specific management, and recommended therapies have been extrapolated from management of other sodium-channel blocking drugs. Traditionally, these therapies have consisted of intravenous fluids, sodium bicarbonate, vasopressors, and cardiac pacing. Novel therapies include intravenous fat emulsion and venoarterial extracorporeal membrane oxygenation (VA-ECMO)...
October 2015: American Journal of Emergency Medicine
Kun Il Kim, Hee Sung Lee, Hyoung Soo Kim, Sang Ook Ha, Won Yong Lee, Sang Jun Park, Sun Hee Lee, Tae Hun Lee, Jeong Yeol Seo, Hyun Hee Choi, Kyu Tae Park, Sang Jin Han, Kyung Soon Hong, Sung Mi Hwang, Jae Jun Lee
BACKGROUND: In the emergency department (ED), extracorporeal membrane oxygenation (ECMO) can be used as a rescue treatment modality for patients with refractory circulatory and/or respiratory failure. Serious consideration must be given to the indication, and the PRESERVE and RESP scores for mortality have been investigated. However these scores were validated to predict survival in patients who received mainly veno-venous (VV) ECMO in the intensive care unit. The aim of the present study was to investigate the factors that predicted the outcomes for patients who received mixed mode (veno-arterial [VA] and VV) ECMO support in the ED...
2015: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Narjust Duma, Christian Barlow, Larysa Sanchez, Sean Sadikot
A 61-year-old Caucasian man with hypertension and hepatitis C presented to the emergency department with 7 days of productive cough and low-grade fevers despite outpatient therapy with oral azithromycin. On initial evaluation, he was lethargic with peripheral cyanosis and oxygen saturation in the low 70 s on room air, necessitating endotracheal intubation. Chest imaging revealed diffuse bilateral infiltrates compatible with the diagnosis of acute respiratory distress syndrome. Patient subsequently developed profound hypoxaemia and on day 2 of admission, veno-veno extracorporeal membrane oxygenation (ECMO) was initiated...
2015: BMJ Case Reports
Jarrod M Mosier, Cameron Hypes, Raj Joshi, Sage Whitmore, Sairam Parthasarathy, Charles B Cairns
Acute respiratory failure is commonly encountered in the emergency department (ED), and early treatment can have effects on long-term outcome. Noninvasive ventilation is commonly used for patients with respiratory failure and has been demonstrated to improve outcomes in acute exacerbations of chronic obstructive lung disease and congestive heart failure, but should be used carefully, if at all, in the management of asthma, pneumonia, and acute respiratory distress syndrome. Lung-protective tidal volumes should be used for all patients receiving mechanical ventilation, and FiO2 should be reduced after intubation to achieve a goal of less than 60%...
November 2015: Annals of Emergency Medicine
Joseph A Palatinus, Sarah B Lieber, Katherine E Joyce, Jeremy B Richards
BACKGROUND: Hypokalemia is a reversible cause of cardiac arrest in patients presenting to the emergency department (ED). Extracorporeal membrane oxygenation (ECMO) is an established technology for cardiopulmonary support with emerging roles in resuscitation. Here, we review the literature of hypokalemic-induced cardiac arrests and discuss one such case successfully managed with ECMO. CASE REPORT: A 23-year-old Central American man who presented to a community ED under federal custody with several days of nausea and vomiting was found to have a serum potassium level of 1...
August 2015: Journal of Emergency Medicine
Lynn P Gehrmann, John W Hafner, Daniel L Montgomery, Klayton W Buckley, Randall S Fortuna
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) therapy has supported critically ill pediatric patients in the intensive care unit setting with cardiac and respiratory failure. This therapy is beginning to transition to the emergency department setting. OBJECTIVE OF REVIEW: This article describes the fundamentals of ECMO and familiarizes the emergency medicine physician with its use in critically ill pediatric patients. DISCUSSION: ECMO can be utilized as either venoarterial (VA) or venovenous (VV), to support oxygenation and perfusion in respiratory failure, sepsis, cardiac arrest, and environmental hypothermia...
October 2015: Journal of Emergency Medicine
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