Background
The role of extracorporeal membrane oxygenation (ECMO) for patients with refractory respiratory failure due to coronavirus 2019 (COVID‐19) is still unclear even now over a year into the pandemic. ECMO is becoming more commonplace even at smaller community hospitals. While the advantages of venovenous (VV) ECMO in acute respiratory distress syndrome (ARDS) from COVID‐19 have not been fully determined, we believe the benefits outweighed the risks in our patient population. Here we describe all patients who underwent VV ECMO at our center.
Methods
All patients placed on ECMO at our center since the beginning of the pandemic, May 5, 2020, until February 20, 2021 were included in our study. All patients placed on ECMO during the time period described above were followed until discharge or death. The primary endpoint was in‐hospital death. Secondary outcomes included discharge disposition, that is, whether patients were sent to a long‐term acute care center (LTAC), inpatient rehabilitation, or went directly home.
Results
A total of 41 patients were placed on VV ECMO for refractory acute respiratory failure. Survival to discharge, the primary end point, was 63.4% (26/41). Inpatient mortality was 36.6% (15/41).
Conclusions
We show here that a successful high‐volume VV ECMO program for ARDS is achievable at even a medium‐size community hospital. We think our success can be replicated by most small‐ and medium‐size community hospitals with cardiothoracic surgery programs and intensivist teams.
BackgroundRhabdomyolysis is a condition characterized by leakage of muscle cell contents and is associated with necrosis and acute kidney injury, which can lead to morbidity and mortality. 1 Though rhabdomyolysis is often caused by direct injury and prolonged immobilization, several medications, including succinylcholine, have been implicated in muscle damage. 2 Succinylcholine is a depolarizing neuromuscular blocker that is used for intubation and carries a black box warning in pediatric patients due to a risk of rhabdomyolysis, hyperkalemia, ventricular arrhythmias, and cardiac arrest in patients with skeletal muscle myopathy. 2 Rhabdomyolysis from succinylcholine is caused by the upregulation of acetylcholine receptors, leading to the depolarization of the muscle and rapid release of potassium. 3 To date, there have been few reports of adult patients with no underlying muscular disorder experiencing rhabdomyolysis attributable to succinylcholine. We describe a patient who experienced cardiac arrest, rhabdomyolysis, hyperkalemia, and acute kidney injury after receipt of succinylcholine for rapid sequence intubation. The Naranjo adverse drug reaction probability scale for this case is 5, which is considered probable.
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