Acute and Critical Care

Cardiology
Risk factors for cannula-associated arterial thrombosis following extracorporeal membrane oxygenation support: a retrospective study: Ngan Hoang Kim Trieu, Xuan Thi Phan, Linh Thanh Tran, Huy Minh Pham, Dai Quang Huynh, Tuan Manh Nguyen, Anh Tuan Mai, Quan Quoc Minh Du, Bach Xuan Nguyen, Thao Thi Ngoc Pham; Acute Crit Care. 2023;38(3):315-324. Published online August 23, 2023; DOI: https://doi.org/10.4266/acc.2023.00500

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Background
Hemostatic dysfunction during extracorporeal membrane oxygenation (ECMO) due to blood-circuit interaction and the consequences of shear stress imposed by flow rates lead to rapid coagulation cascade and thrombus formation in the ECMO system and blood vessels. We aimed to identify the incidence and risk factors for cannula-associated arterial thrombosis (CaAT) post-decannulation.
Methods
A retrospective study of patients undergoing arterial cannula removal following ECMO was performed. We evaluated the incidence of CaAT and compared the characteristics, ECMO machine parameters, cannula sizes, number of blood products transfused during ECMO, and daily hemostasis parameters in patients with and without CaAT. Multivariate analysis identified the risk factors for CaAT.
Results
Forty-seven patients requiring venoarterial ECMO (VA-ECMO) or hybrid methods were recruited for thrombosis screening. The median Sequential Organ Failure Assessment score was 11 (interquartile range, 8–13). CaAT occurred in 29 patients (61.7%), with thrombosis in the superficial femoral artery accounting for 51.7% of cases. The rate of limb ischemia complications in the CaAT group was 17.2%. Multivariate analysis determined that the ECMO flow rate–body surface area (BSA) ratio (100 ml/min/m2) was an independent factor for CaAT, with an odds ratio of 0.79 (95% confidence interval, 0.66–0.95; P=0.014).
Conclusions
We found that the incidence of CaAT was 61.7% following successful decannulation from VA-ECMO or hybrid modes, and the ECMO flow rate–BSA ratio was an independent risk factor for CaAT. We suggest screening for arterial thrombosis following VA-ECMO, and further research is needed to determine the risks and benefits of such screening.

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Has the role of veno-arterial extracorporeal membrane oxygenation in patients with cardiogenic shock following acute myocardial infarction been fully determined? A case report
Kha Minh Nguyen, Hai Phuong Nguyen Tran, Vi Tuong Dang, Sy Van Hoang, Josip Andelo Borovac, Dmitry Duplyakov, Chiara De Biase, Pok-Tin Tang
European Heart Journal - Case Reports.2024;[Epub] CrossRef

Meta-analysis
Comparison of safety and efficacy between therapeutic or intermediate versus prophylactic anticoagulation for thrombosis in COVID-19 patients: a systematic review and meta-analysis: Hyeon-Jeong Lee, Hye Jin Jang, Won-Il Choi, Joonsung Joh, Junghyun Kim, Jungeun Park, Miyoung Choi; Acute Crit Care. 2023;38(2):160-171. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01424; Correction in: Acute Crit Care 2023;38(4):516

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Abstract PDF Supplementary Material

Background
Patients with coronavirus disease 2019 (COVID-19) infections often have macrovascular or microvascular thrombosis and inflammation, which are known to be associated with a poor prognosis. Heparin has been hypothesized that administration of heparin with treatment dose rather than prophylactic dose for prevention of deep vein thrombosis in COVID-19 patients. Methods: Studies comparing therapeutic or intermediate anticoagulation with prophylactic anticoagulation in COVID-19 patients were eligible. Mortality, thromboembolic events, and bleeding were the primary outcomes. PubMed, Embase, the Cochrane Library, and KMbase were searched up to July 2021. A meta-analysis was performed using random-effect model. Subgroup analysis was conducted according to disease severity. Results: Six randomized controlled trials (RCTs) with 4,678 patients and four cohort studies with 1,080 patients were included in this review. In the RCTs, the therapeutic or intermediate anticoagulation was associated with significant reductions in the occurrence of thromboembolic events (5 studies, n=4,664; relative risk [RR], 0.72; P=0.01), and a significant increase in bleeding events (5 studies, n=4,667; RR, 1.88; P=0.004). In the moderate patients, therapeutic or intermediate anticoagulation was more beneficial than prophylactic anticoagulation in terms of thromboembolic events, but showed significantly higher bleeding events. In the severe patients, the incidence of thromboembolic and bleeding events in the therapeutic or intermediate. Conclusions: The study findings suggest that prophylactic anticoagulant treatment should be used in patients with moderate and severe COVID-19 infection groups. Further studies are needed to determine more individualized anticoagulation guidance for all COVID-19 patients.

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The Community Pharmacy as a Study Center for the Epidemiological Analysis of the Population Vaccination against SARS-CoV-2: Evaluation of Vaccine Safety and Pharmaceutical Service
Jacopo Raffaele Dibenedetto, Michela Cetrone, Marina Antonacci, Domenico Pio Cannone, Stefania Antonacci, Pasquale Bratta, Francesco Leonetti, Domenico Tricarico
Pharmacy.2024; 12(1): 16. CrossRef
Specific and Non-specific Aspects and Future Challenges of ICU Care Among COVID-19 Patients with Obesity: A Narrative Review
Alexandra Beurton, Emma J. Kooistra, Audrey De Jong, Helmut Schiffl, Mercedes Jourdain, Bruno Garcia, Damien Vimpère, Samir Jaber, Peter Pickkers, Laurent Papazian
Current Obesity Reports.2024;[Epub] CrossRef

Infection
Oxygen therapy for sepsis and prevention of complications: Hayk Minasyan; Acute Crit Care. 2022;37(2):137-150. Published online March 17, 2022; DOI: https://doi.org/10.4266/acc.2021.01200

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Abstract PDF

Patients with sepsis have a wide range of respiratory disorders that can be treated with oxygen therapy. Experimental data in animal sepsis models show that oxygen therapy significantly increases survival, while clinical data on the use of different oxygen therapy protocols are ambiguous. Oxygen therapy, especially hyperbaric oxygenation, in patients with sepsis can aggravate existing oxidative stress and contribute to the development of disseminated intravascular coagulation. The purpose of this article is to compare experimental and clinical data on oxygen therapy in animals and humans, to discuss factors that can influence the results of oxygen therapy for sepsis treatment in humans, and to provide some recommendations for reducing oxidative stress and preventing disseminated intravascular coagulation during oxygen therapy.

Citations

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Sequential respiratory support in septic patients undergoing continuous renal replacement therapy: A study based on MIMIC-III database
Chunxia Wang, Jianli Zheng, Yilin Zhao, Tiantian Liu, Yucai Zhang
Heliyon.2024; 10(6): e27563. CrossRef
Personalized medicine targeting different ARDS phenotypes: The future of pharmacotherapy for ARDS?
Florian Blanchard, Arthur James, Mona Assefi, Natacha Kapandji, Jean-Michel Constantin
Expert Review of Respiratory Medicine.2023; 17(1): 41. CrossRef
Current data regarding homeostasis of tissues oxygenation in pathophysiological and therapeutic circumstances
Constantin Munteanu, Mihaela Antonina Călin, Dragoș Manea, Cristina Popescu, Mădălina Iliescu, Elena Valentina Ionescu, Liliana Stanciu, Mihaela Minea, Carmen Oprea, Doinița Oprea, Mariana Rotariu, Gelu Onose
Balneo and PRM Research Journal.2023; 14(Vol.14, no): 565. CrossRef
Current data regarding homeostasis of tissues oxygenation in pathophysiological and therapeutic circumstances
Constantin Munteanu, Mihaela Antonina Călin, Dragoș Manea, Cristina Popescu, Mădălina Iliescu, Elena Valentina Ionescu, Liliana Stanciu, Mihaela Minea, Carmen Oprea, Doinița Oprea, Mariana Rotariu, Gelu Onose
Balneo and PRM Research Journal.2023; 14(Vol.14, no): 565. CrossRef

Neurology/Pulmonary
Extensive and Progressive Cerebral Infarction after Mycoplasma pneumoniae Infection: Yu Hyeon Choi, Hyung Joo Jeong, Bongjin Lee, Hong Yul An, Eui Jun Lee, June Dong Park; Korean J Crit Care Med. 2017;32(2):211-217. Published online December 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00283

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Abstract PDF

Acute cerebral infarctions are rare in children; however they can occur as a complication of a Mycoplasma pneumoniae (MP) infection due to direct invasion, vasculitis, or a hypercoagulable state. We report on the case of a 5-year-old boy who had an extensive stroke in multiple cerebrovascular territories 10 days after the diagnosis of MP infection. Based on the suspicion that the cerebral infarction was associated with a macrolide-resistant MP infection, the patient was treated with levofloxacin, methyl-prednisolone, intravenous immunoglobulin, and enoxaparin. Despite this medical management, cerebral vascular narrowing progressed and a decompressive craniectomy became necessary for the patient’s survival. According to laboratory tests, brain magnetic resonance imaging, and clinical manifestations, the cerebral infarction in this case appeared to be due to the combined effects of hypercoagulability and cytokine-induced vascular inflammation.

Citations

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Stroke associated with Mycoplasma hominis infection: a case report
Anthoula C. Tsolaki, Galaktion Konstantinidis, Stavroula Koukou, Fotini Michali, Despina Georgiadou, Thomas Tegos, Nikolaos D. Michalis
Journal of Medical Case Reports.2021;[Epub] CrossRef
Thrombosis associated with mycoplasma pneumoniae infection (Review)
Jingwei Liu, Yumei Li
Experimental and Therapeutic Medicine.2021;[Epub] CrossRef
Multiple anatomic sites of infarction in a pediatric patient with M. pneumoniae infection, a case report
Devon W. Hahn, Claire E. Atkinson, Matthew Le
BMC Pediatrics.2021;[Epub] CrossRef

Cardiology
Huge Left Ventricular Thrombus and Apical Ballooning associated with Recurrent Massive Strokes in a Septic Shock Patient: Hyun-Jung Lee, Hack-Lyoung Kim, Doyeon Hwang, Chan-Soon Park, Jae-Sung Lim, Eungyu Kang, Joo-Hee Zo; Korean J Crit Care Med. 2016;31(1):39-43. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.39

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Abstract PDF

The most feared complication of left ventricular thrombus (LVT) is the occurrence of systemic thromboembolic events, especially in the brain. Herein, we report a patient with severe sepsis who suffered recurrent devastating embolic stroke. Transthoracic echocardiography revealed apical ballooning of the left ventricle with a huge LVT, which had not been observed in chest computed tomography before the stroke. This case emphasizes the importance of serial cardiac evaluation in patients with stroke and severe medical illness.

Citations

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Spontaneous ventricular thrombosis in patients with inflammatory bowel disease
Stella Pak, Juan Linares, Yan Yatsynovich, David Cha, Dexter Nye, Diana Kaminski, Jillian Costello
Cardiology in the Young.2018; 28(3): 351. CrossRef
Major Trauma induced Left Ventricular Thrombus after Acute Myocardial Infarction
Dong Wook Lee, Ju Hee Ha, Jun Ho Kim, Ki Beom Park, Jae Joon Lee, Han Il Choi, Jin Hee Kim
Journal of Lipid and Atherosclerosis.2016; 5(2): 163. CrossRef

Fatal Left Ventricular Thrombosis in an Infant Receiving Extracorporeal Membrane Oxygenation Support: A Case Report: Hwa Jin Cho, Byung Young Kim, Eun Song Song, Sang Gi Oh, Bong Suk Oh, In Seok Jeong; Korean J Crit Care Med. 2013;28(2):123-126.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.123

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Abstract PDF

Thromboembolism in patients receiving extracorporeal membrane oxygenation (ECMO) support is a feared complication. Systemic anticoagulation during ECMO in patients with a massively dilated left ventricle (LV) and decreased LV systolic function is still debated. Hearin, we report a case of a 5-month old infant on ECMO support who had fatal thrombus formation in the massively dilated LV and a consequent thromboembolic event.

Citations

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Activated Partial Thromboplastin Time Versus Anti-Factor Xa Monitoring of Heparin Anticoagulation in Adult Venoarterial Extracorporeal Membrane Oxygenation Patients
Caitlin E. Kulig, Kendra J. Schomer, Hugh B. Black, William E. Dager
ASAIO Journal.2021; 67(4): 411. CrossRef
Anticoagulation Therapy during Extracorporeal Membrane Oxygenator Support in Pediatric Patients
Hwa Jin Cho, Do Wan Kim, Gwan Sic Kim, In Seok Jeong
Chonnam Medical Journal.2017; 53(2): 110. CrossRef

Management of Upper Extremity Deep Vein Thrombosis with a Superior Vena Cava Filter - A Case Report -: Wooil Kwon, Ho Geol Ryu, Hannah Lee, Yongjae Yoo; Korean J Crit Care Med. 2013;28(1):59-63.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.59

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Abstract PDF: Upper extremity deep vein thrombosis (UEDVT) is relatively uncommon and superior vena cava (SVC) filter placements are not often encountered due to strict indication. A 33-year old male with underlying protein C/S deficiency and secondary liver cirrhosis was admitted because of hematemesis. The patient was conservatively managed, but underwent elective splenectomy to prevent aggravation of gastric varix. During postoperative care, the patient underwent cholecystectomy for acalculous cholecystitis. During the postoperative course, UEDVT was detected and heparinization was initiated. The patient experienced repeated attacks of severe dyspnea, which was accompanied by chest pain that lasted for 3 to 10 minutes. Repeated episodes of pulmonary thromboembolism were suspected and SVC filter was placed. Warfarin treatment was initiated and the SVC filter was removed about one month later. The case highlights the clinical significance of UEDVT and reports rare case of SVC filter placement. Intensivists should have comprehensive understanding of UEDVT and its management.

Thrombosed Fusiform Aneurysm Presented as Transient Lateral Medullary Ischemia: A Case Report: Ha Cheol Choi, Hyoung Seok Lim, Sun Young Oh, Byoung Soo Shin; Korean J Crit Care Med. 2012;27(1):52-54.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.52

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Abstract PDF: The frequency of vertebral artery aneurysm is rare and a common presenting sign is subarachnoid hemorrhage. Lateral medullary syndrome is characterized by loss of pain and temperature sensation on the contra lateral lesion side of the body and ipsilateral lesion side of the face, dysphagia, dysarthria, ataxia, vertigo, nystagmus, and Horner syndrome. Vertebral artery dissecting aneurysm is a common cause of lateral medullary infarction. We present a rare case of a 46-year old male patient that developed ischemic attack presenting as transient lateral medullary syndrome due to thrombosed-fusiform aneurysm of vertebral artery. He was treated with aspirin and heparin, and then discharged with complete resolution of symptoms.

The Management of Heparin-induced Thrombocytopenia with Thrombosis after Open Heart Surgery: A Case Report: Jae Bum Kim, Sae Young Choi, Nam Hee Park; Korean J Crit Care Med. 2010;25(3):168-171.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.168

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Abstract PDF: Heparin-induced thrombocytopenia (HIT) is a prothrombotic, immune-mediated adverse reaction to heparin therapy. It is caused by antibodies binding to a complex of heparin and platelet factor 4, and this leads to platelet activation, excessive thrombin generation and often thrombosis. HIT with thrombosis (HITT) can lead to limb amputation, stroke, myocardial infarction and death. We report here on a case of a HITT patient who was successfully managed with argatroban therapy. Further knowledge is need about the ideal medical management for HITT.

The Effect of Hemodilution Treatment for Patient with Hemorrhagic Cerebral Venous Thrombosis due to Iron Deficiency Anemia: A Case Report: Mi Hye Lim, Sun Young Oh, Young Hyun Kim, Byoung Soo Shin; Korean J Crit Care Med. 2009;24(1):47-50.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.47

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Abstract PDF: Cerebral venous sinus thrombosis (CVT) is a rare disease that's associated with a wide variety of clinical signs and symptoms, and CVT is a potentially lethal condition. Iron deficiency anemia (IDA) as the cause of an adult case of CVT is very rare. We report here on a patient with CVT with intracerebral hemorrhage that was caused by IDA, and the patient was treated with hemodilution. We suggest that hemodilution should be considered as another therapeutic option for CVT with cerebral hemorrhage in a patient suffering with IDA.

Perioperative Management for the Patient with May-Thurner Syndrome: A Case Report: Soo Kyung Lee, Eun Joo Choi, Kun Il Kim, Young Mi Kim, Hyun Choi, Hyun Soo Moon; Korean J Crit Care Med. 2008;23(2):115-119.; DOI: https://doi.org/10.4266/kjccm.2008.23.2.115

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Abstract PDF: May-Thurner syndrome is an anatomic variant in which the left common iliac vein is compressed by the right common iliac artery. The most frequent clinical presentation is deep vein thrombosis of the left lower extremity. We report the perioperative management in a patient with May-Thurner syndrome undergoing an open reduction of a tibia fracture. The patient developed deep vein thrombosis of the left lower extremity and had an endovascular stent placed approximately 1 year earlier. An important aspect of the perioperative management in a patient with May-Thurner syndrome is to prevent deep vein thrombosis. We monitored the activated clotting time during the intraoperative period.

Pulmonary Embolism Detected in the General Ward after Operation: A Case Report: Se Hyun Lew, Jong Hun Jun, Hee Koo Yoo, Yong Ho Kim; Korean J Crit Care Med. 2004;19(1):38-41.

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Abstract PDF: Pulmonary embolism is a common medical complication following major orthopedic procedures of the lower extremities and a leading cause of morbidity and mortality. However, the clinical manifestations of pulmonary embolism are nonspecific and it may be difficult to diagnose. An 82 years old female with severe restrictive pulmonary disease received the elective operation for the fracture of left femur neck under combined spinal-epidural anesthesia. During the operation, we sometimes gave her oxygen via face mask and maintained oxygen saturation of more than 80% which was measured by a pulse oxymeter. The operation and anesthesia was performed uneventfully. On the seventh postoperative day, she showed tachycardia suddenly and cardiac arrest later on the electrocardiogram. After cardiopulmonary resuscitation, she was transferred to intensive care unit and checked by a computed tomography and echocardiography. She was diagnosed with pulmonary embolism and deep vein thrombosis and treated with heparin and urokinase. But she did not improve and died.

Right Internal Jugular Venous Thrombosis Occurred after Long-term Placement of Hemodialysis Catheter Inserted Via Right Subclavian Vein: A Case Report: Mi Young Park, Il Woo Shin, Ju Tae Sohn, Heon Keun Lee, Young Kyun Chung; Korean J Crit Care Med. 2003;18(2):80-83.

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Abstract PDF: Central venous catheter-related venous thrombosis is one of the most important complications occurred after central venous catheterization. Forty six year old man had end-stage renal failure due to diabetes mellitus. Temporary hemodialysis catheter was inserted via right subclavian vein. Thirty days after hemodialysis catheter insertion, the patient presented with right neck swelling and difficulty to aspirate blood from hemodialysis catheter. Venography showed right internal jugular vein thrombosis. We report a case in which a patient developed right internal jugular vein thrombosis after long-term placement of temporary hemodialysis catheter.

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