Pharmacokinetics of Total and Unbound Cefazolin during Veno-Arterial Extracorporeal Membrane Oxygenation: A Case Report

Chemotherapy ◽  
2019 ◽  
Vol 64 (3) ◽  
pp. 115-118
Author(s):  
Jayesh A. Dhanani ◽  
Jeffrey Lipman ◽  
Jason Pincus ◽  
Shane Townsend ◽  
Amelia Livermore ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Impaired Renal Function ◽  
Massive Pulmonary Embolism ◽  
Antibiotic Administration ◽  
Extra Corporeal Membrane Oxygenation ◽  
Blood Samples ◽  
Membrane Oxygenation ◽  
Drug Concentrations ◽  
Ecmo Therapy ◽  
Refractory Cardiac Arrest

Extra-corporeal membrane oxygenation (ECMO) therapy could affect effective drug concentrations via adsorption onto the oxygenator or associated circuit. We describe a case of a 25-year-old female who required a veno-arterial ECMO therapy for refractory cardiac arrest due to massive pulmonary embolism. She had mild renal dysfunction as a result of the cardiac arrest. A total of 2 g of intravenous cefazolin 8-hourly was administered. Pre- and post-oxygenator blood samples were collected at 0, 1, 4, and 8 h post antibiotic administration. Samples were analyzed for total and unbound cefazolin concentrations. Protein binding was ∼60%. Clearance was reduced due to impaired renal function. The pharmacokinetics of cefazolin appear to not be affected by ECMO therapy and dosing adjustment may not be required.

Extracorporeal membrane oxygenation in life-threatening massive pulmonary embolism

Perfusion ◽  
2019 ◽  
Vol 34 (6) ◽  
pp. 467-474 ◽  
Author(s):  
Benedict Kjaergaard ◽  
Jens Hedegaard Kristensen ◽  
Jesper Eske Sindby ◽  
Susanne de Neergaard ◽  
Bodil Steen Rasmussen
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Massive Pulmonary Embolism ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Life Threatening ◽  
Femoral Vessels ◽  
Surgical Thrombectomy ◽  
One Year ◽  
Hospital Team

Introduction: In massive pulmonary embolism (PE) with circulatory collapse or with cardiac arrest, treatment can be difficult. Often, the diagnosis is unclear, and the time to treatment is crucial. Our institution has had an out-of-hospital team intended for the treatment of accidental hypothermia with extra corporeal membrane oxygenation (ECMO) since 2004. The team has occasionally been involved in patients suffering massive PE. Methods: We were called to 38 patients with PE, but two were assessed as untreatable. Seventeen were treated with cardiopulmonary resuscitation followed by veno-arterial ECMO. Nineteen were prepared for ECMO with sheaths in the femoral vessels and were intensively observed during diagnosis and treatment. Five of these patients later progressed to ECMO due to cardiac arrest during treatment with thrombolytic medication. Most of the patients were treated with heparin and thrombolytic medication, but if the medications were contraindicated, they were treated with either surgical thrombectomy or only with heparin awaiting spontaneous thrombolysis. Results: Of the 36 patients we intended to treat, 25 (69%) survived one month and 20 survived one year (56%). Of the 22 patients treated with ECMO, 11 survived one month (50%) and 10 survived one year (45%). Discussion: The treatment could have been more uniform. It seems reasonable to build up a PE alert team with ECMO capability to take care of patients with massive PE. Conclusion: The treatment of thrombolytic medications in massive PE is risky, but if the patient is treated or prepared for ECMO, it can be lifesaving.

Extracorporeal membrane oxygenation for refractory cardiac arrest: a retrospective multicenter study

2020 ◽  
Vol 46 (5) ◽  
pp. 973-982 ◽  
Author(s):  
Dirk Lunz ◽  
Lorenzo Calabrò ◽  
Mirko Belliato ◽  
Enrico Contri ◽  
Lars Mikael Broman ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Multicenter Study ◽  
Membrane Oxygenation ◽  
Retrospective Multicenter Study ◽  
Refractory Cardiac Arrest

An urgent open surgical approach for left ventricle venting during peripheral veno-arterial extracorporeal membrane oxygenation for refractory cardiac arrest: case report

Perfusion ◽  
2019 ◽  
Vol 35 (1) ◽  
pp. 82-85 ◽  
Author(s):  
Christophe Beyls ◽  
Pierre Huette ◽  
Mathieu Guilbart ◽  
Alphonse Nzonzuma ◽  
Osama Abou Arab ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Aortic Valve ◽  
Left Ventricle ◽  
Extracorporeal Membrane Oxygenation ◽  
Transesophageal Echocardiography ◽  
Surgical Approach ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Membrane Oxygenation ◽  
Refractory Cardiac Arrest

The objective of the study is to describe an emergency procedure for left ventricle venting during veno-arterial extracorporeal life support for refractory cardiac arrest. Veno-arterial extracorporeal membrane oxygenation is widely used in refractory cardiac arrest but is characterized by an increase in left ventricle afterload, which may impair cardiac contractility improvement. Different left ventricle venting techniques are available. We report the use of a surgical approach with sternotomy for left ventricle venting in a 21-year-old patient who was placed under veno-arterial extracorporeal membrane oxygenation for refractory cardiac arrest with severe pulmonary edema, respiratory failure, and left ventricle stasis. A 21-year-old woman was admitted for laparoscopic sleeve gastrectomy. In the recovery room, she developed a refractory circulatory shock. Transthoracic echocardiography revealed a dilated cardiomyopathy with severe left ventricle systolic dysfunction (left ventricle ejection fraction at 20%). Coronary angiogram was normal. On day 2, she underwent laparotomy for sepsis and she presented cardiac arrest secondary to ventricular tachycardia. We proceeded to peripheral veno-arterial extracorporeal membrane oxygenation as the cardiac arrest was refractory. A miniaturized veno-arterial extracorporeal membrane oxygenation system was implanted into the right femoral vessels onsite .The low flow duration was 40 minutes. Veno-arterial extracorporeal membrane oxygenation blood flow was set to 3 L min−1, resulting in a closed aortic valve and a massive pulmonary edema. Transesophageal echocardiography showed left ventricular ejection fraction at 5% without aortic valve opening. We first implanted an intra-aortic balloon pump without clinical improvement. Transesophageal echocardiography revealed massive thrombus formation into the aortic root. We decided to perform an open surgical approach for left ventricle unload using a transmitral cannula (22 Fr) via the right superior pulmonary vein connected to the inflow tube of the veno-arterial extracorporeal membrane oxygenation with Y connection. Transesophageal echocardiography showed a full opening of aortic valve and elimination of valve aortic thrombus. Chest radiography showed a significant decrease of pulmonary congestion. We were able to withdraw extracorporeal life support organization on day 10 and discharged on day 54. Clinical explorations reveal a fulminant rocuronium-related hypersensitivity myocarditis. This salvage surgical technique using a modified central veno-arterial extracorporeal membrane oxygenation cannulation technique has efficiently decreased blood stasis and permitted rapid recovery.

scholarly journals The use of veno-venous extracorporeal membrane oxygenation following thrombolysis for massive pulmonary embolism

2017 ◽  
Vol 18 (4) ◽  
pp. 342-347 ◽  
Author(s):  
Alister Seaton ◽  
Luke E Hodgson ◽  
Ben Creagh-Brown ◽  
Adrian Pakavakis ◽  
Duncan LA Wyncoll ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Massive Pulmonary Embolism ◽  
Spontaneous Circulation ◽  
Short Term ◽  
Excellent Outcome ◽  
Cardiorespiratory Failure ◽  
Membrane Oxygenation ◽  
Retrieval Team

A 59-year-old man was diagnosed with a massive pulmonary embolism. Despite thrombolysis there were two episodes of cardiac arrest and following recovery of spontaneous circulation profound cardiorespiratory failure ensued. An extracorporeal membrane oxygenation retrieval team initiated veno-venous extracorporeal membrane oxygenation on site to facilitate transfer to the extracorporeal membrane oxygenation centre. An excellent outcome is reported in the short term. This represents one of the few published cases of veno-venous extracorporeal membrane oxygenation for a massive pulmonary embolism following thrombolysis.

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