399: SYSTEMIC THROMBOLYSIS AND ECPR FOR FATAL MIS-C WITH EXTENSIVE CORONARY THROMBOSIS AND CARDIAC ARREST

Catastrophic antiphospholipid syndrome (CAPS) is a lethal disease that occurs suddenly and progresses to multi-organ failure. We present a case of CAPS successfully treated with the rituximab biosimilar CT-P10. A 38-year-old man was referred with a sustained fever and unexplained elevated creatinine levels. Cardiac arrest by ventricular fibrillation occurred upon arrival at the hospital. We diagnosed probable CAPS because of coronary thrombus, renal impairment, suspected diffuse alveolar hemorrhage, and positive anticardiolipin antibody immunoglobulin G. We performed percutaneous coronary intervention for the cardiac arrest, and treated him with extracorporeal membrane oxygenation, mechanical ventilation, and continuous renal replacement therapy. When CAPS was diagnosed, we administered CT-P10 after administering high-dose glucocorticoid. Our case suggests that the use of a rituximab biosimilar is economically efficient in the treatment of CAPS, as in other rheumatic diseases. The patient was cured without recurrence at the 2-year follow-up.

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Use and clinical outcome of veno-arterial extracorporeal membrane oxygenation in patients with acute pulmonary embolism and cardiopulmonary resuscitation

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.146 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

L Hobohm ◽

I Sagoschen ◽

T Gori ◽

FP Schmidt ◽

T Muenzel ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cardiac Arrest ◽

Mortality Rate ◽

Cardiopulmonary Resuscitation ◽

Acute Pulmonary Embolism ◽

Treatment Strategies ◽

Hospital Death ◽

Systemic Thrombolysis ◽

Va Ecmo ◽

Acute Pe

Abstract Funding Acknowledgements Type of funding sources: None. Background Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for patients with acute pulmonary embolism (PE) and concomitant cardiac arrest with the necessity of cardiopulmonary resuscitation (CPR). Little is known about the use and clinical outcome of veno-arterial (VA)-ECMO and adjunctive treatment strategies in patients with acute PE and CPR. Purpose In this context, we aimed to investigate the use of VA-ECMO alone or after systemic thrombolysis and its impact on in-hospital outcomes of patients with acute PE and CPR. Methods We analyzed data on the characteristics, treatments and in-hospital outcomes for all patients with acute PE (ICD-code I26) and CPR in Germany between the years 2005 and 2018 (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005-2018, own calculations). Results Between 2005 and 2018, 1,172,354 patients with acute PE (53.5% females) were included in this analysis; of those, 77,196 (6.5%) presented with cardiac arrest and CPR. While more than one fourth of those patients were treated with systemic thrombolysis alone (n = 20,839 patients; 27.0%), a minority received a combination of thrombolysis + VA-ECMO (n = 165; 0.2%) or singular approach with VA-ECMO treatment alone (n = 588; 0.8%). The overall in-hospital mortality rate of PE patients with cardiac arrest was high with 83.8%. Non-survivors were considerable older than survivors (74 [IQR 63-81] vs. 69 [58-77]). In patients treated with VA ECMO alone the mortality rate was 71.1% and 69.7% when patients received Thrombolysis + VA-ECMO. Patients, who received thrombolysis without VA-ECMO had a higher mortality rate (83.8%). In order to investigate the impact of those different treatment strategies, a multivariate logistic regression analysis (adjusted for age, sex and comorbidities) demonstrated the lowest risk for in-hospital death in patients, who underwent the combination of Thrombolysis + VA-ECMO (OR, 0.61 [95% CI, 0.43-0.86], P = 0.004) or VA-ECMO alone (OR, 0.70 [0.58-0.84], P < 0.001) compared to patients without VA-ECMO and without thrombolysis. Use of thrombolysis alone in patients with PE and CPR lowering the risk regarding in-hospital death as well (OR, 0.95 [0.91-0.99], P = 0.013). Regarding temporal trends, the annual use of VA-ECMO increased from 0 in the year 2005 to the number of 138 in 2018 (ß 6.13 (4.62-6.76); p < 0.001) as well as for the combined treatment Thrombolysis + VA-ECMO (from 0 to 39 [ß 4.28 (3.68-4.89); p < 0.001]). Conclusion Patients with acute PE and CPR had a very high in-hospital mortality rate. Our data suggest, that VA-ECMO alone or after systemic thrombolysis should be considered as an option in this outstanding life-threatening situation to improve in-hospital outcome. Furthermore, our data highlight a marked increase in the number of PE patients treated with VA-ECMO indicating the structural health care progress between 2005 and 2018.

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Systemic thrombolysis for refractory cardiac arrest due to presumed myocardial infarction

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2020.07.053 ◽

2020 ◽

Cited By ~ 2

Author(s):

Joseph A. Hamera ◽

Noah B. Bryant ◽

Mark S. Shievitz ◽

David A. Berger

Keyword(s):

Myocardial Infarction ◽

Cardiac Arrest ◽

Systemic Thrombolysis ◽

Refractory Cardiac Arrest

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A Unique Case of COVID-19-related Acute Coronary Thrombosis Complicated by Severe Hypokalemia

Military Medicine ◽

10.1093/milmed/usab100 ◽

2021 ◽

Author(s):

Matthew Lavoie ◽

Ariana Ramirez ◽

Jeffrey Kunz

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Cardiac Arrest ◽

Coronary Thrombosis ◽

White Male ◽

Coronary Intervention ◽

Unique Case ◽

First Case ◽

Percutaneous Coronary ◽

St Elevation

ABSTRACT We report the case of a 52-year-old white male who was recently diagnosed with symptomatic coronavirus disease-2019 (COVID-19) and presented to the hospital with ventricular tachycardia/ventricular fibrillation cardiac arrest, ST elevation myocardial infarction, and profound hypokalemia. The patient was successfully treated with primary percutaneous coronary intervention and concurrent aggressive potassium repletion. To the authors’ knowledge, this is the first case of COVID-19 presenting not only with an acute coronary thrombosis but also severe hypokalemia, both of which contributed to his cardiac arrest. The association of COVID-19 with acute coronary thrombosis, including the challenges surrounding the diagnosis and management in this patient population, is discussed. Additionally, the effect of COVID-19 on the renin–angiotensin–aldosterone system is reviewed with a focus on hypokalemic presentations.

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Successful Cardiac Massage for Cardiac Arrest Following Coronary Thrombosis

BMJ ◽

10.1136/bmj.1.5167.155 ◽

1960 ◽

Vol 1 (5167) ◽

pp. 155-157 ◽

Cited By ~ 11

Author(s):

R. S. Walton

Keyword(s):

Cardiac Arrest ◽

Coronary Thrombosis ◽

Cardiac Massage

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Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a case series and review of the literature

Perfusion ◽

10.1177/0267659118786830 ◽

2018 ◽

Vol 34 (1) ◽

pp. 22-28 ◽

Cited By ~ 19

Author(s):

Rasha Al-Bawardy ◽

Kenneth Rosenfield ◽

Jorge Borges ◽

Michael N. Young ◽

Mazen Albaghdadi ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Case Series ◽

Massive Pulmonary Embolism ◽

High Morbidity ◽

Systemic Thrombolysis ◽

Membrane Oxygenation ◽

Intravenous Tissue Plasminogen Activator ◽

Surgical Embolectomy

Background: Extracorporeal membrane oxygenation (ECMO) has been used to stabilize patients with massive pulmonary embolism though few reports describe this approach. We describe the presentation, management and outcomes of patients who received ECMO for massive pulmonary embolism (PE) in our pulmonary embolism response team (PERT) registry. Methods: We enrolled a consecutive cohort of patients with confirmed PE for whom PERT was activated and selected patients treated with ECMO. We prospectively captured clinical, therapeutic and outcome data at the time of PERT activation and during the follow-up period for up to 365 days. Results: Thirteen patients who had PERT activation with confirmed PE diagnosis have undergone ECMO since the initiation of our PERT program in 2012. The mean age was 49 ± 19 years. Six (46%) patients were female. All the patients had cardiac arrest, either as an initial presentation or in-hospital cardiac arrest after presentation. All the patients exhibited right ventricular (RV) dilation on echocardiogram with RV hypokinesis. Eight (62%) patients received systemic thrombolysis with intravenous tissue plasminogen activator (tPA) and three (23%) patients underwent catheter-directed thrombolysis therapy using the EKOS system (EKOS Corporation, Bothell, WA, USA). Four (31%) patients underwent surgical embolectomy. Mean ECMO duration was 5.5 days, ranging from 2-18 days. Thirty-day mortality was 31% and one-year mortality was 54%. Conclusions: Patients with massive pulmonary embolism who suffer a cardiac arrest have high morbidity and mortality. ECMO can be used in conjunction with systemic thrombolysis, catheter-directed therapy or as a bridge to surgical embolectomy.

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COVID-19 CARDIAC ARREST DUE TO PRINZMETAL'S ANGINA IN A PREVIOUSLY NORMAL HEART

10.22541/au.161693906.65464346/v1 ◽

2021 ◽

Author(s):

Melinda Wang ◽

Andrew Talon ◽

Mehrdad Saririan

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Arrest ◽

Coronary Thrombosis ◽

Coronary Vasospasm ◽

Cardiac Complications ◽

Normal Heart ◽

Coronary Syndrome ◽

Increased Risk ◽

Unusual Occurrence

There has been a compelling body of evidence of COVID-19 causing cardiac complications such as myocarditis and increased risk of coronary thrombosis. Acute coronary syndrome due to coronary vasospasm is an unusual occurrence.

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