Acute and Critical Care

Original Article

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

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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

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Baylor University Medical Center Proceedings.2023; : 1. CrossRef
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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
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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
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Catheterization and Cardiovascular Interventions.2022; 100(2): 274. CrossRef
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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
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Case Reports

Neurosurgery
Cardiac Arrest from Patient Position Change after Spine Surgery on a Jackson Table: Boohwi Hong, Seok Hwa Yoon, Soo-Yong Park, Seunghyun Song, Ann Youn, Ja Gyung Hwang; Acute Crit Care. 2019;34(1):86-91. Published online February 20, 2017; DOI: https://doi.org/10.4266/acc.2016.00794

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3 Citations

Abstract PDF

The Jackson table has minimal effects on cardiac function because it does not elevate abdominal and thoracic pressures. In addition, it decreases venous congestion and increases exposure of the surgical field. However, the hips and knees are flexed with inappropriate padding, and venostasis is promoted and increased. Pulmonary thromboembolism (PTE) is fatal; thus immediate diagnosis and treatment are essential. However, clinical signs of intraoperative PTE are difficult to discern. Thrombolytic therapy can be considered as first-line therapy, but bleeding limits its use. The authors report a case of PTE resulting from patient positional change after spine surgery, and the use of immediate postoperative recombinant tissue-type plasminogen activator.

Citations

Citations to this article as recorded by

Perioperative patient positioning following scalp tumor surgery: an anesthetic challenge
Rajnish Kumar, Nishant Sahay, Shagufta Naaz, Ansarul Haq, Rajesh Kumar
Ain-Shams Journal of Anesthesiology.2022;[Epub] CrossRef
Differential diagnosis of intraoperative cardiac arrest after spine surgery in prone position
DaviBrasil Khouri, MarinaAyres Delgado, JadsonLardy Lemes, MarcelaMorais Afonso Cruz
Saudi Journal of Anaesthesia.2022; 16(4): 485. CrossRef
Pulmonary thromboembolism due to venostasis induced by sitting position during clavicle and pelvic bone fracture surgery
Soomin LEE, Boohwi HONG, Woosik HAN, Man-Shik SHIM, Yoon-Hee KIM, Seok-Hwa YOON
Chirurgia.2021;[Epub] CrossRef

A Case of Massive Pulmonary Thromboembolism Associated with Ramsay Hunt Syndrome: A Case Report: Jong Hoo Lee, Seong Joo Koh, Gil Myeong Seong, Miok Kim, Jae Chun Lee, Sang Hoon Han, Jay Chol Choi, Yee Hyung Kim; Korean J Crit Care Med. 2011;26(4):267-271.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.267

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Abstract PDF: Ramsay Hunt syndrome associated with the Varicella zoster virus (VZV) infection is characterized by vesicles on the pinna, otalgia, facial nerve palsy and sensorineural hearing loss. Although significant complications from VZV infection are increasing, thrombosis associated with VZV infection is one of the rare complications in adults. The VZV itself could cause endothelial damage in the various organs. Subsequently, the thrombosis might be complicated. A previously healthy 84 year-old female patient was diagnosed with Ramsay Hunt syndrome. On the 7th day of antiviral treatment, she complained of sudden breathlessness. She was hypoxemic with an elevated alveolar-arterial oxygen difference and needed to be supported by mechanical ventilation. Massive pulmonary thrombosis was documented by computerized tomography and she successfully underwent thrombolytic therapy. We report a case of massive pulmonary thromboembolism associated with VZV infection, treated with thrombolytic therapy.

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