Acute and Critical Care

Images in critical care

Pulmonary
Acute lung injury following occupational exposure to nitric acid: Ji Hoon Jang, Sung Yeon Hwang, Chi Ryang Chung, Gee Young Suh, Ryoung-Eun Ko; Acute Crit Care. 2021;36(4):395-396. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.01557

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Erratum

Cardiology
Application of sepsis-3 criteria to Korean patients with critical illnesses: Jae Yeol Kim, Hwan Il Kim, Gee Young Suh, Sang Won Yoon, Tae-Yop Kim, Sang Haak Lee, Jae Young Moon, Jae-Young Kwon, Sungwon Na, Ho Geol Ryu, Jisook Park, Younsuck Koh; Acute Crit Care. 2019;34(2):172-172. Published online April 2, 2019; DOI: https://doi.org/10.4266/acc.2018.00318.e1; Corrects: Acute Crit Care 2019;34(1):30

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Original Articles

Infection
Application of Sepsis-3 Criteria to Korean Patients with Critical Illnesses: Jae Yeol Kim, Hwan Il Kim, Gee Young Suh, Sang Won Yoon, Tae-Yop Kim, Sang Haak Lee, Jae Young Moon, Jae-Young Kwon, Sungwon Na, Ho Geol Ryu, Jisook Park, Younsuck Koh; Acute Crit Care. 2019;34(1):30-37. Published online January 29, 2019; DOI: https://doi.org/10.4266/acc.2018.00318; Correction in: Acute Crit Care 2019;34(2):172

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Background
The 2016 Society of Critical Care Medicine (SCCM)/European Society of Intensive Care Medicine (ESICM) task force for Sepsis-3 devised new definitions for sepsis, sepsis with organ dysfunction and septic shock. Although Sepsis-3 was data-driven, evidence-based approach, East Asian descents comprised minor portions of the project population. Methods: We selected Korean participants from the fever and antipyretics in critically ill patients evaluation (FACE) study, a joint study between Korea and Japan. We calculated the concordance rates for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria and evaluated mortality rates of sepsis, sepsis with organ dysfunction, and septic shock by Sepsis-3 criteria using the selected data. Results: Korean participants of the FACE study were 913 (383 with sepsis and 530 without sepsis by Sepsis-2 criteria). The concordance rate for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria was 55.4%. The intensive care unit (ICU) and 28-day mortality rates of sepsis, sepsis with organ dysfunction, and septic shock patients according to Sepsis-3 criteria were 26.2% and 31.0%, 27.5% and 32.5%, and 40.8% and 43.4%, respectively. The quick Sequential Organ Failure Assessment (qSOFA) was inferior not only to SOFA but also to systemic inflammatory response syndrome (SIRS) for predicting ICU and 28-day mortality. Conclusions: The concordance rates for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria were low. Mortality rate for septic shock in Koreans was consistent with estimates made by the 2016 SCCM/ESICM task force. SOFA and SIRS were better than qSOFA for predicting ICU and 28-day mortality in Korean ICU patients.

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HYPOTENSION AT THE TIME OF SEPSIS RECOGNITION IS NOT ASSOCIATED WITH INCREASED MORTALITY IN SEPSIS PATIENTS WITH NORMAL LACTATE LEVELS
Ji Hwan Kim, Yong Kyun Kim, Dong Kyu Oh, Kyeongman Jeon, Ryoung-Eun Ko, Gee Young Suh, Sung Yun Lim, Yeon Joo Lee, Young-Jae Cho, Mi-Hyeon Park, Sang-Bum Hong, Chae-Man Lim, Sunghoon Park
Shock.2023; 59(3): 360. CrossRef
The Surviving Sepsis Campaign: research priorities for the administration, epidemiology, scoring and identification of sepsis
Mark E. Nunnally, Ricard Ferrer, Greg S. Martin, Ignacio Martin-Loeches, Flavia R. Machado, Daniel De Backer, Craig M. Coopersmith, Clifford S. Deutschman, Massimo Antonelli, Judith Hellman, Sameer Jog, Jozef Kesecioglu, Ishaq Lat, Mitchell M. Levy
Intensive Care Medicine Experimental.2021;[Epub] CrossRef

Hematology
Characteristics and Clinical Outcomes of Critically Ill Cancer Patients Admitted to Korean Intensive Care Units: Soo Jin Na, Tae Sun Ha, Younsuck Koh, Gee Young Suh, Shin Ok Koh, Chae-Man Lim, Won-Il Choi, Young-Joo Lee, Seok Chan Kim, Gyu Rak Chon, Je Hyeong Kim, Jae Yeol Kim, Jaemin Lim, Sunghoon Park, Ho Cheol Kim, Jin Hwa Lee, Ji Hyun Lee, Jisook Park, Juhee Cho, Kyeongman Jeon; Acute Crit Care. 2018;33(3):121-129. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00143

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Abstract PDF

Background
The objective of this study was to investigate the characteristics and clinical outcomes of critically ill cancer patients admitted to intensive care units (ICUs) in Korea.
Methods
This was a retrospective cohort study that analyzed prospective collected data from the Validation of Simplified Acute Physiology Score 3 (SAPS3) in Korean ICU (VSKI) study, which is a nationwide, multicenter, and prospective study that considered 5,063 patients from 22 ICUs in Korea over a period of 7 months. Among them, patients older than 18 years of age who were diagnosed with solid or hematologic malignancies prior to admission to the ICU were included in the present study.
Results
During the study period, a total of 1,762 cancer patients were admitted to the ICUs and 833 of them were deemed eligible for analysis. Six hundred fifty-eight (79%) had solid tumors and 175 (21%) had hematologic malignancies, respectively. Respiratory problems (30.1%) was the most common reason leading to ICU admission. Patients with hematologic malignancies had higher Sequential Organ Failure Assessment (12 vs. 8, P<0.001) and SAPS3 (71 vs. 69, P<0.001) values and were more likely to be associated with chemotherapy, steroid therapy, and immunocompromised status versus patients with solid tumors. The use of inotropes/ vasopressors, mechanical ventilation, and/or continuous renal replacement therapy was more frequently required in hematologic malignancy patients. Mortality rates in the ICU (41.7% vs. 24.6%, P<0.001) and hospital (53.1% vs. 38.6%, P=0.002) were higher in hematologic malignancy patients than in solid tumor patients.
Conclusions
Cancer patients accounted for one-third of all patients admitted to the studied ICUs in Korea. Clinical characteristics were different according to the type of malignancy. Patients with hematologic malignancies had a worse prognosis than did patients with solid tumor.

Citations

Citations to this article as recorded by

Predictors of ICU mortality in patients with hemoblastosis and infectious complications
A.V. Lyanguzov, A.S. Luchinin, S.V. Ignatyev, I.V. Paramonov
Anesteziologiya i reanimatologiya.2023; (1): 33. CrossRef
Effect of the underlying malignancy on critically ill septic patient's outcome
Man‐Yee Man, Hoi‐Ping Shum, Sin‐Man Lam, Jacky Li, Wing‐Wa Yan, Mei‐Wan Yeung
Asia-Pacific Journal of Clinical Oncology.2022; 18(4): 473. CrossRef
Impacts of Corticosteroid Therapy at Acute Stage of Hospital-Onset Clostridioides difficile Infections
Ching-Chi Lee, Jen-Chieh Lee, Chun-Wei Chiu, Pei-Jane Tsai, Wen-Chien Ko, Yuan-Pin Hung
Infection and Drug Resistance.2022; Volume 15: 5387. CrossRef
Hospital mortality and prognostic factors in critically ill patients with acute kidney injury and cancer undergoing continuous renal replacement therapy
Da Woon Kim, Geum Suk Jang, Kyoung Suk Jung, Hyuk Jae Jung, Hyo Jin Kim, Harin Rhee, Eun Young Seong, Sang Heon Song
Kidney Research and Clinical Practice.2022; 41(6): 717. CrossRef
A Systematic Review and Meta-Analysis Evaluating Geographical Variation in Outcomes of Cancer Patients Treated in ICUs
Lama H. Nazer, Maria A. Lopez-Olivo, Anne Rain Brown, John A. Cuenca, Michael Sirimaturos, Khader Habash, Nada AlQadheeb, Heather May, Victoria Milano, Amy Taylor, Joseph L. Nates
Critical Care Explorations.2022; 4(9): e0757. CrossRef
Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study
Jigeeshu Divatia, Amit M Narkhede, Harish K Chaudhari, Ujwal Dhundi, Natesh Prabu Ravisankar, Satish Sarode
Indian Journal of Critical Care Medicine.2021; 25(12): 1421. CrossRef

Letter to the Editor

CPR/Resuscitation
Refractory Ventricular Arrhythmia Induced by Aconite Intoxication and Its Treatment with Extracorporeal Cardiopulmonary Resuscitation: Mi Kyoung Hong, Jeong Hoon Yang, Chi-Ryang Chung, Jinkyeong Park, Gee Young Suh, Kiick Sung, Yang Hyun Cho; Korean J Crit Care Med. 2017;32(2):228-230. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00017

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Citations

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Accidental poisoning with Aconitum: Case report and review of the literature
Giuseppe Bonanno, Mariachiara Ippolito, Alessandra Moscarelli, Giovanni Misseri, Rosaria Caradonna, Giuseppe Accurso, Andrea Cortegiani, Antonino Giarratano
Clinical Case Reports.2020; 8(4): 696. CrossRef

Erratum

Primary Invasive Intestinal Aspergillosis in a Non-Severely Immunocompromised Patient: Eunmi Gil, Tae Sun Ha, Gee Young Suh, Chi Ryang Chung, Chi-Min Park; Korean J Crit Care Med. 2016;31(3):263-263. Published online August 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.129.e01; Corrects: Acute Crit Care 2016;31(2):129

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Case Reports

Infection
Primary Invasive Intestinal Aspergillosis in a Non-Severely Immunocompromised Patient: Eunmi Gil, Tae Sun Ha, Gee Young Suh, Chi Ryang Chung, Chi-Min Park; Korean J Crit Care Med. 2016;31(2):129-133. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.129; Correction in: Acute Crit Care 2016;31(3):263

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Abstract PDF

Invasive aspergillosis (IA) is most commonly seen in patients with risk factors, such as cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation and acquired immune deficiency syndrome. IA commonly occurs in the respiratory tract. Extrapulmonary aspergillosis is usually a part of a disseminated infection, and primary invasive intestinal aspergillosis is very rare. Herein, we report a case of an immunocompetent 53-year-old male who suffered recurrent septic shock in the intensive care unit (ICU) and was finally diagnosed as invasive intestinal aspergillosis without dissemination. IA is rarely considered for patients who do not have an immune disorder. Thus, when such cases do occur, the diagnosis is delayed and the clinical outcome is often poor. However, there is a growing literature reporting IA cases in patients without an immune disorder, mostly among ICU patients. Primary intestinal aspergillosis should be considered for critically ill patients, especially with severe disrupted gastrointestinal mucosal barrier.

Citations

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Aspergillus fumigatus cholangitis in a patient with cholangiocarcinoma: case report and review of the literature
Kathrin Rothe, Sebastian Rasch, Nina Wantia, Alexander Poszler, Joerg Ulrich, Christoph Schlag, Wolfgang Huber, Roland M. Schmid, Dirk H. Busch, Tobias Lahmer
Infection.2021; 49(1): 159. CrossRef

Cardiology
Use of Polymyxin B Hemoperfusion in a Patient with Septic Shock and Septic Cardiomyopathy Who Was Placed on Extracorporeal Membrane Oxygen Support: Sun Hye Shin, Hyun Lee, Aeng Ja Choi, Kylie Hae Jin Chang, Gee Young Suh, Chi Ryang Chung; Korean J Crit Care Med. 2016;31(2):123-128. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.123

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Abstract PDF: Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.

Pulmonary
Successful Treatment with Empirical Erlotinib in a Patient with Respiratory Failure Caused by Extensive Lung Adenocarcinoma: Suk Hyeon Jeong, Sang-Won Um, Hyun Lee, Kyeongman Jeon, Kyung Jong Lee, Gee Young Suh, Man Pyo Chung, Hojoong Kim, O Jung Kwon, Yoon La Choi; Korean J Crit Care Med. 2016;31(1):44-48. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.44

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We herein describe a 70-year-old woman who presented with respiratory failure due to extensive lung adenocarcinoma. Despite advanced disease, care in the intensive care unit with ventilator support was performed because she was a newly diagnosed patient and was considered to have the potential to recover after cancer treatment. Because prompt control of the cancer was needed to treat the respiratory failure, empirical treatment with an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor was initiated before confirmation of EGFR-mutant adenocarcinoma, and the patient was successfully treated. Later, EGFR-mutant adenocarcinoma was confirmed.

Citations

Citations to this article as recorded by

Lung cancer with superior vena cava syndrome diagnosed by intravascular biopsy using EBUS-TBNA
Daegeun Lee, Seong Mi Moon, Dongwuk Kim, Juwon Kim, Haseong Chang, Bumhee Yang, Suk Hyeon Jeong, Kyung Jong Lee
Respiratory Medicine Case Reports.2016; 19: 177. CrossRef

Infection
Disseminated Gastrointestinal Mucormycosis in Immunocompromised Disease: Tae Sun Ha, Chi-Min Park, Jeong Hoon Yang, Yang Hyun Cho, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh; Korean J Crit Care Med. 2015;30(4):323-328. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.323

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Abstract PDF

Mucormycosis is an uncommon opportunistic fungal infection mostly affecting immunocompromised patients and gastrointestinal mucormycosis is a rare and life-threatening. We describe a 31-year-old man with a history of idiopathic cyclic neutropenia who developed perforations of the stomach and intestine and intra-abdominal bleeding due to disseminated gastrointestinal mucormycosis after the initial operation.

Citations

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A Fatal Case of Disseminated Intestinal Mucormycosis in a Patient with Vibrio Sepsis
Seungwoo Chung, Hyun-Jung Sung, Jong Won Chang, Ile Hur, Ho Cheol Kim
Journal of Acute Care Surgery.2021; 11(3): 133. CrossRef
Gastric Mucormycosis Followed by Traumatic Cardiac Rupture in an Immunocompetent Patient
Sang Won Lee, Hyun Seok Lee
The Korean Journal of Gastroenterology.2016; 68(2): 99. CrossRef

Infection/Surgery
Refractory Septic Shock Treated with Nephrectomy under the Support of Extracorporeal Membrane Oxygenation: Young Kun Lee, Jeong Am Ryu, Jeong Hoon Yang, Chi-Min Park, Gee Young Suh, Kyeongman Jeon, Chi Ryang Chung; Korean J Crit Care Med. 2015;30(3):176-179. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.176

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Abstract PDF: Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN), for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.

Original Article

Pulmonary
Factors Affecting Invasive Management after Unplanned Extubation in an Intensive Care Unit: A Lan Lee, Chi Ryang Chung, Jeong Hoon Yang, Kyeongman Jeon, Chi-Min Park, Gee Young Suh; Korean J Crit Care Med. 2015;30(3):164-170. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.164

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Background
Unplanned extubation (UE) of patients requiring mechanical ventilation in an intensive care unit (ICU) is associated with poor outcomes for patients and organizations. This study was conducted to assess the clinical features of patients who experienced UE and to determine the risk factors affecting reintubation after UE in an ICU.
Methods
Among all adult patients admitted to the ICU in our institution who required mechanical ventilation between January 2011 and December 2013, those in whom UE was noted were included in the study. Data were categorized according to noninvasive or invasive management after UE.
Results
The rate of UE was 0.78% (the number of UEs per 100 days of mechanical ventilation). The incidence of self-extubation was 97.2%, while extubation was accidental in the remaining patients. Two cases of cardiac arrest combined with respiratory arrest after UE were noted. Of the 214 incidents, 54.7% required invasive management after UE. Long duration of mechanical ventilation (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.32-1.75; p = 0.000) and high ICU mortality (OR 4.39; 95% CI 1.33-14.50; p = 0.015) showed the most significant association with invasive management after UE. In multivariate analysis, younger age (OR 0.96; 95% CI 0.93-0.99; p = 0.005), medical patients (OR 4.36; 95% CI 1.95-9.75; p = 0.000), use of sedative medication (OR 4.95; 95% CI 1.97-12.41; p = 0.001), large amount of secretion (OR 2.66; 95% CI 1.01-7.02; p = 0.049), and low PaO2/FiO2 ratio (OR 0.99; 95% CI 0.98-0.99; p = 0.000) were independent risk factors of invasive management after UE.
Conclusions
To prevent unfavorable clinical outcomes, close attention and proper ventilatory support are required for patients with risk factors who require invasive management after UE.

Citations

Citations to this article as recorded by

Re-Intubation Among Critical Care Patients: A Scoping Review
Thandar Soe Sumaiyah Jamaludin, Mohd Said Nurumal, Nur Syila Syahida Syaziman, Syuhada Suhaimi, Muhammad Kamil Che Hasan
INTERNATIONAL JOURNAL OF CARE SCHOLARS.2021; 4(Supp1): 93. CrossRef

Case Reports

Thoracic Surgery
Subclavian Artery Laceration Caused by Pigtail Catheter Removal in a Patient with Pneumothorax: Hyo Jin Kim, Yang Hyun Cho, Gee Young Suh, Jeong Hoon Yang, Kyeongman Jeon; Korean J Crit Care Med. 2015;30(2):119-122. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.119

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Abstract PDF

We report a case of subclavian artery laceration caused by the removal of a pigtail pleural drainage catheter in a patient with a pneumothorax. The patient was successfully resuscitated through diagnostic angiography with subsequent balloon occlusion and primary repair of the injured subclavian artery. Although pigtail drainage of a pneumothorax is known to be safe and effective, proper insertion and removal techniques should be emphasized to reduce the risk of complications.

Citations

Citations to this article as recorded by

A randomised controlled trial of intrapleural balloon intercostal chest drains to prevent drain displacement
Rachel M. Mercer, Eleanor Mishra, Radhika Banka, John P. Corcoran, Cyrus Daneshvar, Rakesh K. Panchal, Tarek Saba, Melanie Caswell, Sarah Johnstone, Daniel Menzies, Sana Ahmer, Mitra Shahidi, Amelia O. Clive, Manish Gautam, Giles Cox, Chris Orton, Judith
European Respiratory Journal.2022; 60(1): 2101753. CrossRef
AN UNUSUAL COMPLICATION OF PIGTAIL CATHETER: COLONIC PENETRATION
Yakup Ülger, Anıl Delik
Gastroenterology Nursing.2021; 44(6): 463. CrossRef
Median Sternotomy for the Management of Life-Threatening Bleeding Resulting from Proximal Upper Extremity Amputation
Hyunseong Kang, Gyu Bum Seo, Su Wan Kim
Journal of Acute Care Surgery.2020; 10(2): 58. CrossRef

Cardiology/Pulmonary
Complicated Pulmonary Pseudocyst Following Traumatic Lung Injury Rescued by Extracorporeal Membrane Oxygenation: Sung Bum Park, Dae Sang Lee, Jeong Am Ryu, Jong Ho Cho, Yang Hyun Cho, Chi Ryang Chung, Jeong Hoon Yang, Kyeongman Jeon, Gee Young Suh, Chi Min Park; Korean J Crit Care Med. 2014;29(3):201-206. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.201

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Abstract PDF: Traumatic pulmonary pseudocyst is a rare complication of blunt chest trauma that usually appears immediately in children or young adults and is characterized by a single or multiple pulmonary cystic lesions on chest radiography and has spontaneous resolution of the radiologic manifestations. However, we experienced a case of a delayed complicated pulmonary pseudocyst in a 17-year-old boy following severe traumatic acute respiratory distress syndrome rescued by Veno-venous extracorporeal membrane oxygenation (ECMO). In this case, the pseudocyst appeared on the 12th day after trauma and transformed into an infected cyst. Veno-venous ECMO was successfully maintained for 20 days without anticoagulation.

Cardiology
Use of Extracorporeal Membrane Oxygenation for Optimal Organ Donation: Jeong Hoon Yang, Yang Hyun Cho, Chi Ryang Chung, Kyeongman Jeon, Chi Min Park, Gee Young Suh; Korean J Crit Care Med. 2014;29(3):194-196. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.194

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Abstract PDF

We report a case of extracorporeal membrane oxygenation (ECMO) support for donor organ preservation in a brain-dead patient following out-of-hospital cardiac arrest. A 43-year-old male patient was referred to the emergency department after an out-of-hospital cardiac arrest caused by ventricular fibrillation. Spontaneous circulation was restored after 8 minutes of cardiopulmonary resuscitation. ECMO was implemented because of hemodynamic deterioration. The patient then underwent coronary angiography and was implanted with a drug-eluting stent because of occlusion at the proximal portion of the right coronary artery. After 144 hours, brain death was established, and ECMO support for optimal oxygen delivery was sustained until organ retrieval after consent for donation was received from the family. Liver and kidneys were successfully transplanted to three recipients, respectively.

Citations

Citations to this article as recorded by

Extracorporeal Membrane Oxygenation for the Support of a Potential Organ Donor with a Fatal Brain Injury before Brain Death Determination
Sung Wook Chang, Sun Han, Jung Ho Ko, Jae-Wook Ryu
Korean Journal of Critical Care Medicine.2016; 31(2): 169. CrossRef
The Use of Extracorporeal Circulation in Suspected Brain Dead Organ Donors with Cardiopulmonary Collapse
Hyun Lee, Yang Hyun Cho, Kiick Sung, Jeong Hoon Yang, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh
Journal of Korean Medical Science.2015; 30(12): 1911. CrossRef

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