- Pulmonary
-
The role of nafamostat mesilate as a regional anticoagulant during extracorporeal membrane oxygenation
-
Jae Ha Lee, Jin Han Park, Ji Hoon Jang, Se Hun Kim, Sung Yong Hong, Woon Heo, Dong-Hwan Lee, Hye Sook Choi, Ki Hoon Kim, Hang-Jea Jang
-
Acute Crit Care. 2022;37(2):177-184. Published online April 20, 2022
-
DOI: https://doi.org/10.4266/acc.2021.01312
-
-
4,226
View
-
253
Download
-
6
Web of Science
-
6
Crossref
-
Abstract
PDF
- Background
Anticoagulation during extracorporeal membrane oxygenation (ECMO) usually is required to prevent thrombosis. The aim of this study was to investigate the usefulness of nafamostat mesilate (NM) as a regional anticoagulant during veno-arterial ECMO (VA-ECMO) treatment. Methods: We retrospectively reviewed the medical records of 16 patients receiving VA-ECMO and NM from January 2017 to June 2020 at Haeundae Paik Hospital. We compared clinical and laboratory data, including activated partial thromboplastin time (aPTT), which was measured simultaneously in patients and the ECMO site, to estimate the efficacy of regional anticoagulation. Results: The median patient age was 68.5 years, and 56.3% of patients were men. Cardiovascular disease was the most common primary disease (75.0%) requiring ECMO treatment, followed by respiratory disease (12.5%). The median duration of ECMO treatment was 7.5 days. Among 16 patients, seven were switched to NM after first using heparin as an anticoagulation agent, and nine received only NM. When comparing aPTT values in the NM group between patients and the ECMO site, that in patients was significantly lower than that at the ECMO site (73.57 vs. 79.25 seconds; P=0.010); in contrast, no difference was observed in the heparin group. Conclusions: NM showed efficacy as a regional anticoagulation method by sustaining a lower aPTT value compared to that measured at the ECMO site. NM should be considered as a safer regional anticoagulation method in VA-ECMO for patients at high risk of bleeding.
-
Citations
Citations to this article as recorded by
- Management of cardiopulmonary bypass in patients with ischemic and hemorrhagic strokes in surgery for active infective endocarditis
Takahiro Yamazato, Hiroshi Munakata, Yutaka Okita Indian Journal of Thoracic and Cardiovascular Surgery.2024; 40(S1): 61. CrossRef - Approach to Decompensated Right Heart Failure in the Acute Setting
Catherine V. Levitt, Caitlin A. Williams, Jalil Ahari, Ali Pourmand Journal of Clinical Medicine.2024; 13(3): 869. CrossRef - Critical Care Management of Severe Asthma Exacerbations
Shameek Gayen, Stephen Dachert, Bilal Lashari, Matthew Gordon, Parag Desai, Gerard Criner, Juan Cardet, Kartik Shenoy Journal of Clinical Medicine.2024; 13(3): 859. CrossRef - Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic Shock
Jan-Sören Padberg, Jannik Feld, Leonie Padberg, Jeanette Köppe, Lena Makowski, Joachim Gerß, Patrik Dröge, Thomas Ruhnke, Christian Günster, Stefan Andreas Lange, Holger Reinecke Journal of Clinical Medicine.2024; 13(4): 1167. CrossRef - Extra-Corporeal Membrane Oxygenation in Pregnancy
Tatsiana Romenskaya, Yaroslava Longhitano, Aman Mahajan, Gabriele Savioli, Antonio Voza, Manfredi Tesauro, Christian Zanza Journal of Clinical Medicine.2024; 13(6): 1634. CrossRef - Anticoagulants in adult extracorporeal membrane oxygenation: alternatives to standardized anticoagulation with unfractionated heparin
Shu Tang, Liqing Xu, Hui Li, Zhanshen Wu, Qiang Wen European Journal of Clinical Pharmacology.2023; 79(12): 1583. CrossRef
- Trauma
-
Tension Pneumothorax after Attempting Insertion of a Central Venous Catheter
-
Ki Hoon Kim
-
Acute Crit Care. 2018;33(4):280-281. Published online November 13, 2018
-
DOI: https://doi.org/10.4266/acc.2017.00598
-
-
18,231
View
-
187
Download
-
1
Web of Science
-
1
Crossref
-
PDF
-
Citations
Citations to this article as recorded by
- Comparison between ultrasound and chest X-ray to confirm central venous catheter tip position
Leoni de Man, Mari Wentzel, Cornel van Rooyen, Edwin Turton South African Journal of Radiology.2023;[Epub] CrossRef
- Toxicology
-
Methidathion Poisoning
-
Ki Hoon Kim, Se Hun Kim, Charles Her
-
Korean J Crit Care Med. 2017;32(4):363-369. Published online January 17, 2017
-
DOI: https://doi.org/10.4266/kjccm.2016.00073
-
-
5,938
View
-
148
Download
-
1
Web of Science
-
1
Crossref
-
Abstract
PDF
- Although methidathion is an organophosphate insecticide, it is different from the other organophosphates in terms of toxicity. Because of its relatively high fat solubility, the apparent volume of methidathion distribution throughout the body is very high, indicating that hemoperfusion is not effective in removing this organophosphate from the body. Redistribution of methidathion from fat to blood can also occur when plasma levels diminish. Additionally, acetylcholinesterase aging, which is the loss of an alkyl side chain that prevents reactivation by oximes, is very rapid so that the effective reactivation by oximes is thwarted. Thus, methidathion’s effect on acetylcholinesterase inhibition is long lasting, particularly with a high dose. In addition to its parasympatholytic effect and ability to induce muscle paralysis, methidathion poisoning is associated with a profound and long-lasting circulatory collapse due to sympathetic ganglion blockade. This report presents the case of a 55-year-old man who accidentally ingested a high dose of methidathion. He later developed enteroinvasive aspergillosis infection-induced multiple bowel perforations on two separate occasions while on mechanical ventilator support, resulting in a fatal outcome. The renin-angiotensin axis activated by sympathetic ganglion blockade may have reduced the patient’s splanchnic blood flow, contributing to translocation of endotoxin. Also, the effect of excessive acetylcholine on non-neuronal acetylcholine receptors may have contributed to the development of fatal enteroinvasive aspergillosis in this patient.
-
Citations
Citations to this article as recorded by
- A case report of acute kidney injury following organophosphate methidathion poisoning
Bilel Chefirat, Anissa Zergui, Haciba Rezk-Kallah Toxicologie Analytique et Clinique.2022; 34(2): 121. CrossRef
|