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Original Articles
Pharmacology
Comparison of the efficacy of an infusion pump or standard IV push injection to deliver naloxone in treatment of opioid toxicity
Bita Dadpour, Maryam Vahabzadeh, Babak Mostafazadeh
Acute Crit Care. 2020;35(1):38-43.   Published online February 29, 2020
DOI: https://doi.org/10.4266/acc.2020.00010
  • 6,879 View
  • 166 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Background
The optimal goal of naloxone infusion in intensive care units is to ameliorate opioid-induced side effects in therapy or eliminate the symptoms of opioid toxicity in overdoses. Accurately monitoring and regulating the doses is critical to prevent adverse effects related to naloxone administration. The present study aimed to compare treatment outcomes when using two methods of intravenous naloxone infusion: an infusion pump or the standard method. Methods: This study involved 80 patients with signs and symptoms of opioid overdose. The patients were randomly assigned into two groups with respect to intravenous infusion of naloxone by either an infusion pump or the standard method. Results: Comparison of study parameters between the two groups at 12 and 24 hours after intervention showed significantly more compensatory acid-base imbalance in the naloxone infusion pump group. In the group that received naloxone by pump, only one patient experienced withdrawal symptoms, but withdrawal symptoms appeared in 12 patients (30.0%) in the standard intravenous infusion group within 12 hours and in seven additional patients (17.5%) within 24 hours of intervention. In the group receiving pump-based naloxone infusion therapy, no another complications were reported; however in the standard infusion group, the 12-hour and 24-hour complication rates were 55.0% and 32.5%, respectively. The length of hospital stay was 2.85±1.05 and 4.22±0.92 days for the pump and standard infusion groups, respectively (P<0.001). Conclusions: Naloxone infusion using an infusion pump may be safer with regard to hemodynamic stability, resulting in shorter hospitalization periods, and fewer posttreatment complications.

Citations

Citations to this article as recorded by  
  • Endogenous opiates and behavior: 2020
    Richard J. Bodnar
    Peptides.2022; 151: 170752.     CrossRef
  • Are opioid receptor antagonists adequate for “Opioid” overdose in a changing reality?
    John F. Peppin, Joseph V. Pergolizzi, Albert Dahan, Robert B. Raffa
    Journal of Clinical Pharmacy and Therapeutics.2021; 46(4): 861.     CrossRef
  • The Efficacy, Safety, and Convenience of a New Device for Flushing Intravenous Catheters (Baro Flush™): A Prospective Study
    Youn I. Choi, Jae Hee Cho, Jun-Won Chung, Kyoung Oh Kim, Kwang An Kwon, Han Yong Chun, Dong Kyun Park, Yoon Jae Kim
    Medicina.2020; 56(8): 393.     CrossRef
Pulmonary
Use of extracorporeal membrane oxygenation in patients with acute high-risk pulmonary embolism: a case series with literature review
You Na Oh, Dong Kyu Oh, Younsuck Koh, Chae-Man Lim, Jin-Won Huh, Jae Seung Lee, Sung-Ho Jung, Pil-Je Kang, Sang-Bum Hong
Acute Crit Care. 2019;34(2):148-154.   Published online May 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00500
  • 7,505 View
  • 222 Download
  • 21 Web of Science
  • 22 Crossref
AbstractAbstract PDF
Background
Although extracorporeal membrane oxygenation (ECMO) has been used for the treatment of acute high-risk pulmonary embolism (PE), there are limited reports which focus on this approach. Herein, we described our experience with ECMO in patients with acute high-risk PE.
Methods
We retrospectively reviewed medical records of patients diagnosed with acute highrisk PE and treated with ECMO between January 2014 and December 2018.
Results
Among 16 patients included, median age was 51 years (interquartile range [IQR], 38 to 71 years) and six (37.5%) were male. Cardiac arrest was occurred in 12 (75.0%) including two cases of out-of-hospital arrest. All patients underwent veno-arterial ECMO and median ECMO duration was 1.5 days (IQR, 0.0 to 4.5 days). Systemic thrombolysis and surgical embolectomy were performed in seven (43.8%) and nine (56.3%) patients, respectively including three patients (18.8%) received both treatments. Overall 30-day mortality rate was 43.8% (95% confidence interval, 23.1% to 66.8%) and 30-day mortality rates according to the treatment groups were ECMO alone (33.3%, n=3), ECMO with thrombolysis (50.0%, n=4) and ECMO with embolectomy (44.4%, n=9).
Conclusions
Despite the vigorous treatment efforts, patients with acute high-risk PE were related to substantial morbidity and mortality. We report our experience of ECMO as rescue therapy for refractory shock or cardiac arrest in patients with PE.

Citations

Citations to this article as recorded by  
  • Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: an overview of current practice and evidence
    Samir Ali, Christiaan L. Meuwese, Xavier J. R. Moors, Dirk W. Donker, Anina F. van de Koolwijk, Marcel C. G. van de Poll, Diederik Gommers, Dinis Dos Reis Miranda
    Netherlands Heart Journal.2024; 32(4): 148.     CrossRef
  • Integration of Extracorporeal Membrane Oxygenation into the Management of High-Risk Pulmonary Embolism: An Overview of Current Evidence
    Romain Chopard, Raquel Morillo, Nicolas Meneveau, David Jiménez
    Hämostaseologie.2024;[Epub]     CrossRef
  • Evidence-Based Management of Massive and Submassive Pulmonary Embolism
    Sara Al-Juboori, Tareq Alzaher, Hashem Al Omari, Sufyan Al Gammaz, Mazen Al-Qadi
    JAP Academy Journal.2024;[Epub]     CrossRef
  • Mechanical Support in High-Risk Pulmonary Embolism: Review Article
    Amer N. Kadri, Razan Alrawashdeh, Mohamad K. Soufi, Adam J. Elder, Zachary Elder, Tamam Mohamad, Eric Gnall, Mahir Elder
    Journal of Clinical Medicine.2024; 13(9): 2468.     CrossRef
  • Extracorporeal membrane oxygenation for large pulmonary emboli
    Timothy J. George, Jenelle Sheasby, Rahul Sawhney, J. Michael DiMaio, Aasim Afzal, Dennis Gable, Sameh Sayfo
    Baylor University Medical Center Proceedings.2023; 36(3): 314.     CrossRef
  • Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association
    Joshua B. Goldberg, Jay Giri, Taisei Kobayashi, Marc Ruel, Alexander J.C. Mittnacht, Belinda Rivera-Lebron, Abe DeAnda, John M. Moriarty, Thomas E. MacGillivray
    Circulation.2023;[Epub]     CrossRef
  • Life-threatening pulmonary embolism: overview and management
    Nizar Osmani, Jonathan Marinaro, Sundeep Guliani
    International Anesthesiology Clinics.2023; 61(4): 35.     CrossRef
  • Extracorporeal Membrane Oxygenation for Pulmonary Embolism: A Systematic Review and Meta-Analysis
    Jonathan Jia En Boey, Ujwal Dhundi, Ryan Ruiyang Ling, John Keong Chiew, Nicole Chui-Jiet Fong, Ying Chen, Lukas Hobohm, Priya Nair, Roberto Lorusso, Graeme MacLaren, Kollengode Ramanathan
    Journal of Clinical Medicine.2023; 13(1): 64.     CrossRef
  • Pulmonary ECMO-ism: Let’s add PEA to ECPR indications
    Zachary Shinar, Alice Hutin
    Resuscitation.2022; 170: 293.     CrossRef
  • Combined use of extracorporeal membrane oxygenation with interventional surgery for acute pancreatitis with pulmonary embolism: A case report
    Ling-Ling Yan, Xiu-Xiu Jin, Xiao-Dan Yan, Jin-Bang Peng, Zhuo-Ya Li, Bi-Li He
    World Journal of Clinical Cases.2022; 10(12): 3899.     CrossRef
  • Pulmonary Embolism Complicated With Cardiopulmonary Arrest Treated With Combination of Thrombolytics and Aspiration Thrombectomy
    Taylor C. Remillard, Zain Kassam, Maks Coven, Aditya Mangla, Zoran Lasic
    JACC: Case Reports.2022; 4(10): 576.     CrossRef
  • Anesthetic management for intraoperative acute pulmonary embolism during inferior vena cava tumor thrombus surgery: A case report
    Pei-Yu Hsu, En-Bo Wu
    World Journal of Clinical Cases.2022; 10(15): 5111.     CrossRef
  • Percutaneous mechanical thrombectomy and extracorporeal membranous oxygenation: A case series
    Haytham Mously, Jamal Hajjari, Tarek Chami, Tarek Hammad, Robert Schilz, Teresa Carman, Yakov Elgudin, Yasir Abu‐Omar, Marc P. Pelletier, Mehdi H. Shishehbor, Jun Li
    Catheterization and Cardiovascular Interventions.2022; 100(2): 274.     CrossRef
  • Clinical Experiences of High-Risk Pulmonary Thromboembolism Receiving Extracorporeal Membrane Oxygenation in Single Institution
    Joonyong Jang, So-My Koo, Ki-Up Kim, Yang-Ki Kim, Soo-taek Uh, Gae-Eil Jang, Wonho Chang, Bo Young Lee
    Tuberculosis and Respiratory Diseases.2022; 85(3): 249.     CrossRef
  • Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation?
    Benjamin Assouline, Marie Assouline-Reinmann, Raphaël Giraud, David Levy, Ouriel Saura, Karim Bendjelid, Alain Combes, Matthieu Schmidt
    Journal of Clinical Medicine.2022; 11(16): 4734.     CrossRef
  • Optimal reperfusion strategy in acute high-risk pulmonary embolism requiring extracorporeal membrane oxygenation support: a systematic review and meta-analysis
    Romain Chopard, Peter Nielsen, Fabio Ius, Serghei Cebotari, Fiona Ecarnot, Hugo Pilichowski, Matthieu Schmidt, Benedict Kjaergaard, Iago Sousa-Casasnovas, Mehrdad Ghoreishi, Rajeev L. Narayan, Su Nam Lee, Gregory Piazza, Nicolas Meneveau
    European Respiratory Journal.2022; 60(5): 2102977.     CrossRef
  • Use of extracorporeal membrane oxygenation in high‐risk acute pulmonary embolism: A systematic review and meta‐analysis
    Luca Baldetti, Alessandro Beneduce, Lorenzo Cianfanelli, Giulio Falasconi, Luigi Pannone, Francesco Moroni, Angela Venuti, Stefania Sacchi, Mario Gramegna, Vittorio Pazzanese, Francesco Calvo, Guglielmo Gallone, Matteo Pagnesi, Alberto Maria Cappelletti
    Artificial Organs.2021; 45(6): 569.     CrossRef
  • Institutional Experience With Venoarterial Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism: A Retrospective Case Series
    Maxwell A. Hockstein, Christina Creel-Bulos, Joshua Appelstein, Craig S. Jabaley, Michael J. Stentz
    Journal of Cardiothoracic and Vascular Anesthesia.2021; 35(9): 2681.     CrossRef
  • Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review*
    John Harwood Scott, Matthew Gordon, Robert Vender, Samantha Pettigrew, Parag Desai, Nathaniel Marchetti, Albert James Mamary, Joseph Panaro, Gary Cohen, Riyaz Bashir, Vladimir Lakhter, Stephanie Roth, Huaqing Zhao, Yoshiya Toyoda, Gerard Criner, Lisa Moor
    Critical Care Medicine.2021; 49(5): 760.     CrossRef
  • Adult Langerhans histiocytosis with rare BRAF mutation complicated by massive pulmonary embolism
    Salma Hassan, Christina Fanola, Amy Beckman, Faqian Li, Andrew C. Nelson, Michael Linden, Joan D. Beckman
    Thrombosis Research.2020; 193: 207.     CrossRef
  • Efficacy and safety of extracorporeal membrane oxygenation for high-risk pulmonary embolism: A systematic review and meta-analysis
    Matteo Pozzi, Augustin Metge, Anthony Martelin, Caroline Giroudon, Justine Lanier Demma, Catherine Koffel, William Fornier, Pascal Chiari, Jean Luc Fellahi, Jean Francois Obadia, Xavier Armoiry
    Vascular Medicine.2020; 25(5): 460.     CrossRef
  • Evidence-Based Minireview: Advanced therapies and extracorporeal membrane oxygenation for the management of high-risk pulmonary embolism
    Radhika Gangaraju, Frederikus A. Klok
    Hematology.2020; 2020(1): 195.     CrossRef
Cardiology/Emergency
Five-year Experience of Extracorporeal Life Support in Emergency Physicians
Yong Soo Cho, Kyoung Hwan Song, Byung Kook Lee, Kyung Woon Jeung, Yong Hun Jung, Dong Hun Lee, Sung Min Lee
Korean J Crit Care Med. 2017;32(1):52-59.   Published online February 28, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00885
  • 7,234 View
  • 154 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
This study aimed to present our 5-year experience of extracorporeal cardiopulmonary resuscitation (ECPR) performed by emergency physicians.
Methods
We retrospectively analyzed 58 patients who underwent ECPR between January 2010 and December 2014. The primary parameter analyzed was survival to hospital discharge. The secondary parameters analyzed were neurologic outcome at hospital discharge, cannulation time, and ECPR-related complications.
Results
Thirty-one patients (53.4%) were successfully weaned from extracorporeal membrane oxygenation, and 18 (31.0%) survived to hospital discharge. Twelve patients (20.7%) were discharged with good neurologic outcomes. The median cannulation time was 25.0 min (interquartile range 20.0-31.0 min). Nineteen patients (32.8%) had ECPR-related complications, the most frequent being distal limb ischemia. Regarding the initial presentation, 52 patients (83.9%) collapsed due to a cardiac etiology, and acute myocardial infarction (33/62, 53.2%) was the most common cause of cardiac arrest.
Conclusions
The survival to hospital discharge rate for cardiac arrest patients who underwent ECPR conducted by an emergency physician was within the acceptable limits. The cannulation time and complications following ECPR were comparable to those found in previous studies.

Citations

Citations to this article as recorded by  
  • Extracorporeal cardiopulmonary resuscitation location, coronary angiography and survival in out-of-hospital cardiac arrest
    Yoonjic Kim, Jeong Ho Park, Sun Young Lee, Young Sun Ro, Ki Jeong Hong, Kyoung Jun Song, Sang Do Shin
    The American Journal of Emergency Medicine.2023; 64: 142.     CrossRef
  • Extracorporeal cardiopulmonary resuscitation for adult out-of-hospital cardiac arrest patients: time-dependent propensity score-sequential matching analysis from a nationwide population-based registry
    Yeongho Choi, Jeong Ho Park, Joo Jeong, Yu Jin Kim, Kyoung Jun Song, Sang Do Shin
    Critical Care.2023;[Epub]     CrossRef
  • Time from arrest to extracorporeal cardiopulmonary resuscitation and survival after out‐of‐hospital cardiac arrest
    Jeong Ho Park, Kyoung Jun Song, Sang Do Shin, Young Sun Ro, Ki Jeong Hong
    Emergency Medicine Australasia.2019; 31(6): 1073.     CrossRef
  • Pre-hospital extra-corporeal cardiopulmonary resuscitation
    Ben Singer, Joshua C. Reynolds, David J. Lockey, Ben O’Brien
    Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2018;[Epub]     CrossRef

ACC : Acute and Critical Care