Successful Use of Extracorporeal Life Support and Continuous Renal Replacement Therapy in the Treatment of Cardiogenic Shock Induced by Tumor Lysis Syndrome in a Pediatric Patient With Lymphoma: A Case Report

The use of extracorporeal membrane oxygenation (ECMO) in the treatment of cardiopulmonary failure in children with malignant tumors is controversial. There are few reports on the use of ECMO in the treatment of children with tumor lysis syndrome. This article reports a case of a 9-year-old girl who presented with hyperkalemia and cardiogenic shock. The discovery of an abdominal mass with critical ultrasound provided key evidence for the initial diagnosis of tumor lysis syndrome. Cardiopulmonary resuscitation was performed for 1 h. Veno-arterial ECMO was installed at the bedside to provide cardiopulmonary support for the patient and was combined with continuous renal replacement therapy (CRRT) to improve her internal environment. The patient was ultimately diagnosed with mature B-cell lymphoma with tumor lysis syndrome. A severe electrolyte disorder led to cardiogenic shock. After the electrolyte imbalance was corrected, the patient's heart function gradually improved, ECMO was successfully weaned, and chemotherapy was continued with the support of CRRT. One month after ECMO weaning, the organ function of the patient had recovered and there were no serious complications. In this case report, we paid attention to the rapid diagnosis of the etiology behind a patient's shock with critical ultrasound as well as the initiation and management of extracorporeal cardiopulmonary resuscitation (ECPR), which provided us with valuable experience using VA-ECMO on critically ill children with tumors. It is also important evidence for the use of ECMO in the treatment of children with cardiopulmonary arrest secondary to malignancy.

Point-of-care critical ultrasound in a rural emergency department

Point-of-care critical ultrasound (CCUS) has changed the management of critically ill patients in the emergency department. It is brought to the bed of patient, images are immediately available and therapy can be monitored making real time changes. Although it is difficult to estimate the real efficacy of CCUS, we evaluated the impact of ultrasound in our emergency department. This study is a cross sectional observational study with 241 cases enrolled. All patients were evaluated by the emergency physician and underwent clinical examination and then CCUS. Patients were then independently evaluated by at least one consultant. A final diagnosis was made after an agreement between the emergency physician and the consultant. Percentages of correct final diagnosis were higher after CCUS than after primary survey: 82.5% <em>vs</em> 49.1% of patients with dyspnea (P&lt;0.001), 71.9% <em>vs</em> 40.6 % with thoracic pain (P=0.03), 76.2% <em>vs</em> 45% with abdominal pain (P&lt;0.001), 80.0% <em>vs</em> 43.6% with suspected deep venous thrombosis (P=0.03) and 80.0% <em>vs</em> 20% with shock (P=0.014). Extended fast assessment for trauma was effective for the management of traumatic patients and correctly ruled out complications in 81.1% of patients (P=0.04). A small number of ultrasound guided invasive procedures were safely and successfully performed. In our study the integration of primary survey with CCUS increased diagnostic capability of the emergency physician and improved overall quality of medical assistance.