Treatment of Acute Severe Asthma Exacerbation with Extracorporeal Membrane Oxygenation and Inhaled Volatile Anesthetic

2021 ◽  
pp. 000313482110474
Author(s):  
Lauren A. Raff ◽  
Andrew B. Schneider ◽  
Anthony G. Charles ◽  
Jared R. Gallaher
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Treatment Options ◽  
Volatile Anesthetic ◽  
Respiratory Acidosis ◽  
Limited Information ◽  
Membrane Oxygenation ◽  
Inhaled Anesthetic ◽  
Refractory Asthma

Severe asthma affects approximately 1-2% of all asthmatic patients. Acute exacerbations are associated with high mortality in this population. There are many treatment options for asthma exacerbation; however, if these treatments fail, patients can develop progressive hypoxia, hypercarbia, respiratory acidosis, and hemodynamic instability. Extracorporeal membrane oxygenation (ECMO) and inhaled anesthetic both have a role in the management of acute severe refractory asthma exacerbation, though there is limited information about the use of both together. We present the case of a patient with severe asthma who suffered a refractory asthma exacerbation and was successfully managed with veno-venous ECMO and inhaled anesthetic. ECMO and inhaled volatile anesthetic both have a role in the management of severe refractory asthma exacerbations. It is safe and beneficial to use these therapies together and more benefit is noted if initiated early in the course of the patient’s illness.

scholarly journals Extracorporeal membrane oxygenation and V/Q ratios: an ex vivo analysis of CO2 clearance within the Maquet Quadrox-iD oxygenator

Perfusion ◽  
2020 ◽  
Vol 35 (1_suppl) ◽  
pp. 29-33 ◽  
Author(s):  
Bishoy Zakhary ◽  
Jayne Sheldrake ◽  
Vincent Pellegrino
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Dead Space ◽  
Gas Flow ◽  
Ex Vivo ◽  
Respiratory Acidosis ◽  
Gas Flows ◽  
Membrane Oxygenation ◽  
In Series ◽  
Membrane Oxygenators ◽  
Different Levels

While hypercapnia is typically well treated with modern membrane oxygenators, there are cases where respiratory acidosis persists despite maximal extracorporeal membrane oxygenation support. To better understand the physiology of gas exchange within the membrane oxygenator, CO2 clearance within an adult Maquet Quadrox-iD oxygenator was evaluated at varying blood CO2 tensions and V/Q ratios in an ex vivo extracorporeal membrane oxygenation circuit. A closed blood-primed circuit incorporating two Maquet Quadrox-iD oxygenators in series was attached to a Maquet PLS Rotaflow pump. A varying blend of CO2 and air was connected to the first oxygenator to provide different levels of pre-oxygenator blood CO2 levels (PvCO2) to the second oxygenator. Varying sweep gas flows of 100% O2 were connected to the second oxygenator to provide different V/Q ratios. Exhaust CO2 was directly measured, and then VCO2 and oxygenator dead space fraction (VD/VT) were calculated. VCO2 increased with increasing gas flow rates with plateauing at V/Q ratios greater than 4.0. Exhaust CO2 increased with PvCO2 in a linear fashion with the slope of the line decreasing at high V/Q ratios. Oxygenator dead space fraction varied with V/Q ratio—at lower ratios, dead space fraction was 0.3-0.4 and rose to 0.8-0.9 at ratios greater than 4.0. Within the Maquet Quadrox-iD oxygenator, CO2 clearance is limited at high V/Q ratios and correlated with elevated oxygenator dead space fraction. These findings have important implications for patients requiring high levels of extracorporeal membrane oxygenation support.

Successful treatment of severe asthma-associated plastic bronchitis with extracorporeal membrane oxygenation

2011 ◽  
Vol 26 (2) ◽  
pp. 265-268 ◽  
Author(s):  
Momoka Tonan ◽  
Soshi Hashimoto ◽  
Akio Kimura ◽  
Hiroki Matsuyama ◽  
Hiromi Kinose ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Severe Asthma ◽  
Successful Treatment ◽  
Plastic Bronchitis ◽  
Membrane Oxygenation

Emergency Use of Occlutech® Atrial Flow Regulator Device Facilitates Weaning From Veno-Arterial Extracorporeal Membrane Oxygenation in a Patient With Severe Pulmonary Arterial Hypertension

2021 ◽  
pp. 088506662110078
Author(s):  
E. Oliver Aregullin ◽  
Bennett P. Samuel ◽  
Reda Girgis ◽  
Joseph J. Vettukattil
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Extracorporeal Membrane Oxygenation ◽  
Arterial Hypertension ◽  
Treatment Options ◽  
Disease Treatment ◽  
Novel Device ◽  
Membrane Oxygenation ◽  
Pulmonary Arterial ◽  
Flow Regulator ◽  
Severe Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is a severe and progressive disease. Treatment options include anti-PAH medications, continuous intravenous therapies, and diuretics. Lung transplant is required in many cases. Atrial septostomy is an under recognized option in symptomatic patients on maximal PAH therapy. However, creating a sustainable and restrictive atrial communication is challenging with existing devices. We describe emergency use of the Occlutech® Atrial Flow Regulator, a novel device, in a 35-year-old female with PAH supported on veno-arterial extracorporeal membrane oxygenation after postpartum decompensation.

scholarly journals Intravenous Ribavirin for Parainfluenza and Respiratory Syncytial Virus in an Infant Receiving Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy

2018 ◽  
Vol 23 (4) ◽  
pp. 337-342
Author(s):  
Cheryl L. Sargel ◽  
Mohammed Aboud ◽  
Aimee Forster ◽  
Loralie J. Langman ◽  
Jessica Tansmore ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Extracorporeal Membrane Oxygenation ◽  
Treatment Options ◽  
Therapeutic Benefit ◽  
Severe Illness ◽  
Membrane Oxygenation ◽  
Period 2 ◽  
Collection Period ◽  
Syncytial Virus ◽  
Vv Ecmo

BACKGROUND Viral bronchiolitis remains a significant cause of hospitalization as well as morbidity and mortality during the first year of life, with treatment options beyond supportive care being limited. In cases of severe illness, ribavirin may offer therapeutic benefit. OBJECTIVE We report the use of intravenous (IV) ribavirin in an infant requiring concomitant venovenous extracorporeal membrane oxygenation (VV-ECMO) and continuous venovenous hemofiltration (CVVH) for respiratory syncytial virus (RSV) and parainfluenza virus (PIV) coinfection. PATIENTS AND METHODS A 5-week-old male former 33-week preterm infant was admitted with respiratory failure and subsequently tested positive for RSV and PIV-type 1 infection. Progressive clinical deterioration subsequently required the initiation of both VV-ECMO and CVVH. Although the patient received combined VV-ECMO and CVVH, IV ribavirin was administered, and serial plasma and ultrafiltrate samples were obtained for pharmacokinetic analyses after the first dose (collection period 1) and again after an estimated 5 half-lives (collection period 2). RESULTS Pharmacokinetics for collection period 1 demonstrated a calculated Cmax of 11.99 mg/L, an AUC0–24 of 43.32 mg·hr/L, ke 0.26 hr−1, t½ 2.69 hr, Vd 10.04 L (2.92 L/kg, using patient's dosing weight 3.43 kg), CLT 43.47 mL/min, and CLCVVH 6.75 mL/min. Pharmacokinetics for collection period 2 demonstrated a calculated Cmax of 10.31 mg/L, AUC0–6 of 52.55 mg· hr/L, ke 0.06 hr−1, t½ 10.69 hr, Vd 17.5 L (5.1 L/kg), and CLT 17.44 mL/min. The sieving coefficient during collection period 1 was 1.17 (range, 1.07–1.37). The percent decline between prefilter and postfilter oxygenator was 19.1%. CONCLUSION Our patient demonstrated therapeutic concentrations of ribavirin, despite drug removal via CVVH and the ECMO oxygenator. Standard ribavirin dosing used and resultant concentrations achieved were associated with viral clearance and clinical improvement.

scholarly journals Volatile anaesthetic for treatment of respiratory failure from status asthmaticus requiring extracorporeal membrane oxygenation

2020 ◽  
Vol 13 (1) ◽  
pp. e231507 ◽  
Author(s):  
Joseph E LaGrew ◽  
Kevin Robert Olsen ◽  
Amanda Frantz
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Status Asthmaticus ◽  
Direct Action ◽  
Respiratory Acidosis ◽  
Pulmonary Haemorrhage ◽  
Volatile Anaesthetics ◽  
Male Smoker ◽  
Ecmo Circuit ◽  
Membrane Oxygenation ◽  
Impaired Pulmonary Function

A 37-year-old male smoker with asthma presented with status asthmaticus refractory to terbutaline, intravenous magnesium, continuous bronchodilators, steroids, heliox and theophylline infusion. He was intubated on hospital day 2 and cannulated for veno-venous extracorporeal membrane oxygenation (V-V ECMO) on hospital day 3 for refractory respiratory acidosis secondary to hypercapnia and hypoxemia despite maximum medical management over 4 days. He was started on inhaled isoflurane with improvement in peak airway pressures and respiratory acidosis, allowing for prompt weaning from V-V ECMO and extubation. Inhaled volatile anaesthetics exert a direct action on bronchiole smooth muscle causing relaxation with significant effect despite severely impaired pulmonary function. This treatment in patients on ECMO may allow for earlier decannulation and decreased risk of coagulopathy, ECMO circuit failure, infection, renal failure, pulmonary haemorrhage and central nervous system haemorrhage. However, major limitations exist in delivering volatile anaesthetics, which may make use inefficient and costly despite efficacy.

scholarly journals Prolonged Cardiac Arrest in Severe Bupropion Intoxication: Everything You Should Know About Anti-Arrhytmics, Transesophageal Echocardiography Guided Resuscitation and Extracorporeal Membrane Oxygenation

2021 ◽  
Vol 7 (1) ◽  
pp. 1-6
Author(s):  
Caitlin Celis ◽  
◽  
Melvin Willems ◽  
Ben Pellens ◽  
Stefanie Vandervelden ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Extracorporeal Membrane Oxygenation ◽  
Extended Release ◽  
Rare Complication ◽  
Treatment Options ◽  
Transoesophageal Echocardiography ◽  
Membrane Oxygenation ◽  
Lidocaine Administration ◽  
Va Ecmo

A 30-year-old woman was admitted to the emergency department one and half hours after severe bupropion extended-release intoxication, estimated to be between 18 and 36 g. She initially presented with seizures and later developed signs of cardiotoxicity with persisting sustained ventricular tachycardia. Despite multiple defibrillation attempts and the administration of sodium bicarbonate, calcium gluconate and magnesium, restoration of sinus rhythm was found unsuccessful. In another attempt to treat this refractory ventricular tachycardia lidocaine was given followed by deterioration to asystole. During cardiopulmonary resuscitation (CPR), the quality of chest compression was assessed and optimised using transoesophageal echocardiography. Eventually venoarterial extracorporeal membrane oxygenation (VA-ECMO) was needed to achieve hemodynamic stability. In this case report we discuss the successful use of VA-ECMO after bupropion intoxication, which has only been reported in 3 other cases but should be considered as one of the treatment options in severe overdose cases. Also, the rare complication of asystole after lidocaine administration and the value of transoesophageal echocardiography during CPR will be discussed.

Cardiac Resuscitation and Coagulation

2014 ◽  
Vol 120 (4) ◽  
pp. 1009-1014 ◽  
Author(s):  
Joseph L. Weidman ◽  
Douglas C. Shook ◽  
Jan N. Hilberath
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Treatment Options ◽  
Review Article ◽  
Cardiac Resuscitation ◽  
Membrane Oxygenation

Abstract Cardiac arrest and its treatment options are frequently associated with significant derangements in coagulation. This review article highlights coagulopathies commonly encountered in cardiac arrest and during treatment with hypothermia, thrombolysis, and extracorporeal membrane oxygenation.

scholarly journals Retroperitoneal Hemorrhage During Veno-Venous Extracorporeal Membrane Oxygenation in COVID-19 Patientss: Clinical Experience and Review of Literature

2020 ◽  
Author(s):  
Jingchen Zhang ◽  
Xujian He ◽  
Jia Hu ◽  
Tong Li
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Clinical Experience ◽  
Virus Disease ◽  
Treatment Options ◽  
Arterial Embolization ◽  
Retroperitoneal Hematoma ◽  
Retroperitoneal Hemorrhage ◽  
Membrane Oxygenation ◽  
Low Incidence ◽  
Ecmo Treatment

Abstract Background: Retroperitoneal hemorrhage is a rare and severe complication in patients undergoing extracorporeal membrane oxygenation (ECMO). Retroperitoneal hematoma after the operation of multiple ECMO in a single center at the same time is extremely rare. The causes and treatment options can provide clinical experience and bring some inspiration.Case presentation: Three cases of retroperitoneal hemorrhage patients with Corona Virus Disease-19 (COVID-19) are introduced; they had respiratory failure and were treated with veno-venous ECMO or veno-arterial-venous ECMO. Retroperitoneal hemorrhage occurred during ECMO treatment. Among the three cases, 2 cases were found due to abdominal pain, and 1 case was found because of a decrease in ECMO circuit flow rate and hemoglobin level. 2 cases were treated with transcatheter arterial embolization, and 1 case was treated conservatively. The hemorrhage in each of the 3 cases did not deteriorate. Through early diagnosis and treatment, satisfactory treatment results were achieved for these 3 patients.Conclusions: During the period of ECMO treatment, there is a low incidence of retroperitoneal hematoma, yet it comes with a high risk. This is due to anticoagulant use and some local mechanical injuries. If a decline in blood flow velocity and hemoglobin is detected, retroperitoneal hematoma should be taken into consideration, and early aggressive therapy should be started.

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