Aprotinin in the management of life-threatening bleeding during extracorporeal life support

Perfusion ◽  
2000 ◽  
Vol 15 (3) ◽  
pp. 211-216 ◽  
Author(s):  
Abhik K Biswas ◽  
Leslie Lewis ◽  
John F Sommerauer
Keyword(s):  
Blood Loss ◽  
Blood Product ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Postoperative Bleeding ◽  
Case Series ◽  
Coagulation Cascade ◽  
Massive Blood Loss ◽  
Dosing Regimens ◽  
Life Threatening

Contact with the synthetic surfaces of an extracorporeal circuit induces alterations in vascular components, derangements of the coagulation cascade and a systemic inflammatory response. Aprotinin reduces intraoperative and postoperative bleeding in adults undergoing cardiopulmonary bypass; however, trials in children have not had similar favorable results. While there have been some anecdotal reports, there have been no prospective clinical trials exploring the utility of aprotinin in the prevention of or as a therapy for bleeding while on extracorporeal life support (ECLS). We present a case series on our experience utilizing aprotinin for the treatment of life-threatening bleeding during ECLS. The combination of a loading dose followed by a continuous infusion resulted in significant reduction in blood loss and blood product utilization. This suggests that aprotinin may have clinical efficacy in the management of massive blood loss while on ECLS; however, larger controlled trials will be essential to determine the efficacy and appropriate dosing regimens before widespread use in ECLS can be advocated.

Risk factors for bleeding in pediatric post-cardiotomy patients requiring ECLS

Perfusion ◽  
2009 ◽  
Vol 24 (3) ◽  
pp. 191-197 ◽  
Author(s):  
Kathryn Nardell ◽  
Gail M Annich ◽  
Jennifer C Hirsch ◽  
Cathe Fahrner ◽  
Pat Brownlee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Blood Product ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Bleeding Complications ◽  
Excessive Bleeding ◽  
Surgical Exploration ◽  
Platelet Counts ◽  
Protamine Administration

Background/Objective: There is limited literature documenting bleeding patterns in pediatric post-cardiotomy patients on extracorporeal life support (ECLS). This retrospective review details bleeding complications and identifies risk factors for bleeding in these patients. Methods: Records from 145 patients were reviewed. Patients were divided into excessive (E) and non-excessive (NE) bleeding groups based on blood loss. Results: Excessive bleeding occurred predominantly from 0-6h. Longer CPB duration (NE=174±8min; E=212±16; p=0.02) and lower platelet counts (NE=104.8±50K; E=84.3±41K; p=0.01) were associated with excessive bleeding during the first 6h (p=0.005). Use of intraoperative protamine with normal platelets was associated with decreased bleeding from 7-12h post-ECLS (p=0.002). Most mediastinal exploration occurred >49h post-ECLS, with decreased bleeding post-exploration in E patients. Conclusions: The majority of pediatric post-cardiotomy ECLS bleeding occurs early after support initiation. Longer CPB time and thrombocytopenia increased bleeding 0-6h post-ECLS. Since early bleeding may be coagulopathic in origin, an approach to minimize bleeding includes protamine administration and aggressive blood product replacement with target platelet counts of 100-120K. Surgical exploration should follow if additional hemostasis is necessary.

Clinical Toxicology of Yew Poisoning

2018 ◽  
Vol 52 (6) ◽  
pp. 591-599 ◽  
Author(s):  
Alexander W. Labossiere ◽  
Dennis F. Thompson
Keyword(s):  
English Language ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Therapeutic Interventions ◽  
Plant Materials ◽  
Search Terms ◽  
Life Threatening

Objectives: Yew plant materials contain highly toxic taxine alkaloids. Serious ingestions can result in life-threatening toxicity. The purpose of this article is to summarize the literature on the treatment of acute yew poisoning. Data Sources: PubMed (January 1946 to November 2017) was searched using the search terms “taxus/po”. EMBASE (1980 to November 2017) was searched using the search terms “taxus/to” and “yew.mp.” Web of Science (1945 to November 2017) was searched using the text words taxus, taxine, and yew. Study Selection and Data Extraction: Available English language articles involving case reports, epidemiology, treatment, and outcomes were included. Data Synthesis: Although not uncommon, unintentional yew poisoning rarely results in significant morbidity or mortality. A total of 26 case reports of yew poisoning were evaluated along with 4 case series articles (totaling 22 additional cases). Only 4 of the 48 total cases (8%) were accidental poisonings, the rest being deliberate ingestions. In 20 patients (42%), it resulted in fatalities. Severe, acute yew poisoning results in symptomatology largely resistant to pharmacotherapy intervention. Conclusions: Most nonintentional ingestions of yew plant constituents are asymptomatic and require little intervention. Severe poisoning can result in life-threatening cardiac toxicity and require aggressive supportive care. Therapeutic interventions, such as sodium bicarbonate, digoxin immune fab, and hemodialysis that have been utilized in case studies and case series in the literature have little proven benefit. Extracorporeal life support should be considered in severe yew poisoning.

Use of Single-Cannula Venous-Venous Extracorporeal Life Support in the Management of Life-Threatening Airway Obstruction

2015 ◽  
Vol 99 (3) ◽  
pp. e63-e65 ◽  
Author(s):  
Michael Ko ◽  
Pedro R. dos Santos ◽  
Tiago N. Machuca ◽  
Katherine Marseu ◽  
Thomas K. Waddell ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Life Threatening

scholarly journals Survival and quality of life after extracorporeal life support for refractory cardiac arrest: A case series

2015 ◽  
Vol 150 (4) ◽  
pp. 947-954 ◽  
Author(s):  
Amedeo Anselmi ◽  
Erwan Flécher ◽  
Hervé Corbineau ◽  
Thierry Langanay ◽  
Vincent Le Bouquin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Series ◽  
Refractory Cardiac Arrest

Extracorporeal membrane oxygenation for Kawasaki disease: two case reports and the Extracorporeal Life Support Organization experience 1999–2015

Perfusion ◽  
2017 ◽  
Vol 32 (7) ◽  
pp. 609-612 ◽  
Author(s):  
Derek Best ◽  
Johnny Millar ◽  
Igor Kornilov ◽  
Yury Sinelnikov ◽  
Roberto Chiletti ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Reports ◽  
Membrane Oxygenation ◽  
Support Organization ◽  
Life Threatening ◽  
Acute Kawasaki Disease ◽  
Cardiac Manifestations

Kawasaki disease is usually a limited illness of early childhood. However, life-threatening cardiac manifestations can occur, either at acute presentation or as a consequence of coronary arterial involvement. We report the successful use of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) for cardiac support in two children with Kawasaki disease: one with acute Kawasaki disease shock syndrome, the other with complications of coronary arteritis and subsequent surgery. We also reviewed the reported experience in the ELSO database and available literature.

scholarly journals ECMO in Poisoning

2017 ◽  
Vol 01 (02) ◽  
pp. 82-88
Author(s):  
Vivek Gupta ◽  
Gurpreet S. Wander
Keyword(s):  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Reports ◽  
Case Series ◽  
Supportive Therapy ◽  
Tissue Perfusion ◽  
Western World ◽  
Hemodynamic Compromise ◽  
The World

AbstractSevere poisoning may lead to life-threatening situation or death due to cardiovascular dysfunction, arrhythmia, or cardiogenic shock. The poisoning substance varies in different parts of world; in the Western world, the drugs with cardiotoxic potential are more common, while pesticides and other household toxins are common in the rest of the world. However, most of these patients are relatively young and otherwise healthy irrespective of poisoning substances. Extracorporeal membrane oxygenation (ECMO) has regained interest in recent past and now its use is being explored for newer indications. The use of ECMO in poisoning has shown promising results as salvage therapy and can be used as bridge to recovery, antidote, and toxin removal with renal replacement therapy or transplant. The ECMO has been used in those poisoned patients who have persistent cardiogenic shock or refractory hypoxemia despite adequate supportive therapy. ECMO may be useful in providing adequate cardiac output and maintain tissue perfusion which helps in the redistribution of toxins from central circulation and facilitate the metabolism and excretion. However, the available literature is not sufficient and is based on case reports, case series, and retrospective cohort study. In spite of high mortality with severe poisoning and encouraging outcome with use of ECMO, it is an underutilized modality across the world. Though evidences suggest that early consideration of ECMO in severely poisoned patients with refractory cardiac arrest or hemodynamic compromise refractory to standard therapies may be beneficial, the right time to start ECMO in poisoned patients, criteria to start ECMO, and prognostication prior to initiation of ECMO is yet to be answered. Future studies and publications may address these issues, whereas the ELSO (Extracorporeal Life Support Organization) data registry may help in collecting global data on poisoning more effectively.

scholarly journals Extracorporeal Life Support for Massive Hemoptysis and Acute Lung Injury Due to ANCA Negative Vasculitis

2021 ◽  
Vol 7 (1) ◽  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Rescue Therapy ◽  
Massive Hemoptysis ◽  
Life Threatening

Massive hemoptysis is life-threatening and extracorporeal membrane oxygenation (ECMO) may be indicated as rescue therapy due to acute lung injury in this setting. We report a case of a patient who presented with massive hemoptysis and acute lung injury after reported inhaled ground oxymorphone abuse. Although initially thought to have been due to inhaled oxymorphone, we determined that the patient had ANCA-negative vasculitis that led to both hemoptysis and hematuria. The role of inhaled oxymorphone in combination with the vasculitis is unknown. ECMO was initiated to support the patient and, although his course was complicated, he did recover. Keywords: ECMO; Vasculitis; Acute Respiratory Distress (ARDS).

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