The statements and opinions expressed in COVID-19 Curbside Consults are based on experience and the available literature as of the date posted. While we try to regularly update this content, any offered recommendations cannot be substituted for the clinical judgment of clinicians caring for individual patients. ABSTRACT Extracorporeal membrane oxygenation (ECMO) is a means of cardiopulmonary support for refractory respiratory and cardiac failure. ECMO is a resource-intensive therapy that can be considered in highly selected patients. Expert centers should employ an evidence-based ARDS treatment algorithm and a multidisciplinary approach to recommending ECMO upon failure of conventional therapy. Caring for ECMO patients requires adequate infection control and safety precautions for healthcare workers.
Introduction: A fulminant pulmonary embolism is a potentially reversible cause of cardiac arrest with a reported mortality rate of up to 95%. Therapeutic strategies for fulminant pulmonary embolism continue to evolve. Case report: We present a case of a 38-year-old female who suffered an in-hospital cardiac arrest due to fulminant pulmonary embolism. Extracorporeal cardiopulmonary resuscitation (facilitated by the LUCAS™ mechanical chest compression device) was successfully performed in this patient following failure of intraarrest thrombolysis. Discussion: For the management of fulminant pulmonary embolism, utilization of clot-directed therapies, especially intraarrest thrombolysis, has garnered increasing traction and interest. However, this therapeutic approach has its limitations. Fortuitously, the emergence of extracorporeal cardiopulmonary resuscitation has added a new dimension to the treatment of fulminant pulmonary embolism. A protocolized approach to treatment can improve outcomes in these patients. Conclusion: Extracorporeal cardiopulmonary resuscitation can be used as a salvage therapy in patients with fulminant pulmonary embolism in whom intraarrest thrombolysis has failed.
Introduction: An upsurge of e-cigarette, or vaping, product use–associated lung injury has been reported in the United States. The potential role of extracorporeal life support in e-cigarette, or vaping, product use–associated lung injury merits consideration. Case report: We present a case of vaping-induced severe acute respiratory distress syndrome that was salvaged with extracorporeal life support and had excellent recovery. Discussion: The mechanistic reasons for the sudden outbreak of e-cigarette, or vaping, product use–associated lung injury are under active investigation. A predominantly diffuse, bilateral pattern of lung injury has been reported, with some cases meeting the criteria for severe acute respiratory distress syndrome. To date, 68 deaths from e-cigarette, or vaping, product use–associated lung injury have been confirmed by the centers of disease control. However, resolution of lung injury has been reported in most cases, thereby justifying candidacy for extracorporeal life support, if required. Conclusion: Extracorporeal life support can be successfully utilized as a bridge to recovery in vaping-induced severe acute respiratory distress syndrome.
The optimal temperature for deep hypothermic circulatory arrest remains undefined. We present a case in which Bispectral Index monitoring during hypothermic cardiopulmonary bypass showed electrocerebral silence at a higher temperature than previously reported. Bispectral Index monitoring may be a potentially useful tool in surgery employing deep hypothermic circulatory arrest.
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