Successful Treatment of Severe Carbon Monoxide Poisoning and Refractory Shock Using Extracorporeal Membrane Oxygenation

Teerapuncharoen, Krittika; Sharma, Nirmal; Barker, Andrew B; Wille, Keith; Diaz-Guzman, Enrique

doi:10.4187/respcare.03990

Cited by 20 publications

(10 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These include poisonings, life-threatening upper-airway obstruction, trauma, refractory air leak from a multitude of underlying infectious or traumatic causes, and even diffuse alveolar hemorrhage. 47,[78][79][80] As experience builds and ECMO technology and practice continues to advance, the rate of high morbidity or high mortality complications from ECMO sup-port will probably decrease, and more case reports will appear of ECMO use for other indications requiring a brief or prolonged period of cardiopulmonary support pending resolution of the underlying disease process.…”

Section: Bridge To Lung Transplantationmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for Severe Pediatric Respiratory Failure

Lin

2017

Respir Care

View full text Add to dashboard Cite

Extracorporeal membrane oxygenation (ECMO) was developed initially in the 1960s to support refractory respiratory failure in addition to the cardiac support inherent in a venoarterial bypass circuit. Early successes occurred predominantly in the neonatal population with subsequent randomized controlled trials and comprehensive reviews concluding therapeutic efficacy for ECMO in neonatal respiratory failure. In contrast, the evidence supporting ECMO for respiratory failure in children is less definitive. However, although pediatric randomized controlled trials have not been completed, sufficient evidence in support of ECMO as a beneficial therapy for pediatric respiratory failure exists. The acceptance of clinical utility and benefit from ECMO for pediatric ARDS and the trend toward increasing venovenous ECMO use have led to its inclusion in the Pediatric Acute Lung Injury Consensus Conference as a strongly agreed upon recommendation for severe pediatric ARDS. However, the Pediatric Acute Lung Injury Consensus Conference recommendations supporting the use of ECMO for pediatric ARDS highlight the lack of evidence-based selection criteria when determining ECMO candidacy in pediatric patients with ARDS. Ultimately, decisions to proceed with ECMO and the concomitant risk of potential life-threatening complications must consider multiple factors that balance potential risks and likelihood of benefit, pre-morbid conditions and impact on potential post-ECMO quality of life, candidacy for lung transplantation, and patient and family goals of care. This review will discuss ECMO for the support of pediatric respiratory failure, ventilator management during ECMO, considerations impacting timing of decannulation, and developing techniques.

show abstract

Section: Bridge To Lung Transplantationmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for Severe Pediatric Respiratory Failure

Lin

2017

Respir Care

View full text Add to dashboard Cite

show abstract

“…19,20 Third, cytopathic hypoxia occurs in CO poisoning as a result of mitochondrial dysfunction, and this may be protective from hypoxic and ischemic injury. 2,21 Similar cytopathic hypoxia is thought to be a main mechanism of multiple-organ dysfunction syndrome in critically ill patients; organ dysfunctions are usually not due to structural changes in organs (ie, necrosis or apoptosis) but rather due to mitochondrial dysfunction with organ stunning or hibernation such that in survivors most organ injury returns to baseline levels of function. [22][23][24] This mechanism was hypothesized to account for reversible myocardial stunning treated with extracorporeal membrane oxygenation in an unresponsive 38-year-old woman with severe CO poisoning who recovered without neurologic sequelae.…”

Section: Discussionmentioning

confidence: 99%

Unreliable Early Neuroprognostication After Severe Carbon Monoxide Poisoning Is Likely Due to Cytopathic Hypoxia: A Case Report and Discussion

2019

View full text Add to dashboard Cite

A 17-year-old girl was found unconscious in a running vehicle. She developed very severe acute respiratory distress syndrome (which was treated with rescue high-frequency oscillation), hemodynamic instability, acute kidney injury, rhabdomyolysis, and remained comatose with a Glasgow Coma Scale score of 3 and gasping respirations for 67 hours (when the Glasgow Coma Scale score improved to 6, with tachypnea to Paco 2 28 and pH 7.5). By 92 hours, she was obeying commands, and she was extubated at 96 hours, shortly after which she was conversing with family and texting on her phone. A magnetic resonance imaging (MRI) scan 6 days after being found showed subacute infarctions affecting the medial aspect of the globus pallidus bilaterally as well as a small cortical/subcortical infarction in the right parietal lobe. At a 7-week follow-up, she had no delayed-onset signs of brain injury. This case demonstrated that neurologic prognostication after carbon monoxide poisoning may be unreliable for more than 72 hours after injury. We discuss that it is possible that the mitochondrial dysfunction induced by carbon monoxide was responsible for a functional coma without irreversible brain injury, similar to the mechanism of cytopathic hypoxia in multiple-organ dysfunction that allows some other organ recovery without necrosis in survivors.

show abstract

“…Extarcorporeal membrane oxygenation (ECMO) has been used as a therapeutic adjunct in pregnant patients with severe respiratory distress as well as patients with severe CO poisoning. 77–80 While not yet reported in the burned pregnant population, ECMO is a potential treatment to manage CO intoxication. 54…”

Section: Treatmentmentioning

confidence: 99%

Carbon Monoxide and Cyanide Poisoning in the Burned Pregnant Patient

Culnan¹,

Craft-Coffman²,

Bitz³

et al. 2018

Annals of Plastic Surgery

View full text Add to dashboard Cite

Carbon monoxide (CO) is a small molecule poison released as a product of incomplete combustion. Carbon monoxide binds hemoglobin, reducing oxygen delivery. This effect is exacerbated in the burned pregnant patient by fetal hemoglobin that binds CO 2.5- to 3-fold stronger than maternal hemoglobin. With no signature clinical symptom, diagnosis depends on patient injury history, elevated carboxyhemoglobin levels, and alterations in mental status. The standard of care for treatment of CO intoxication is 100% normobaric oxygen, which decreases the half-life of CO in the bloodstream from 5 hours to 1 hour. Hyperbaric oxygen (HBO2) is a useful adjunct to rapidly reduce the half-life of CO to 20 minutes and the incidence of delayed neurologic sequelae. Because of the slow disassociation of CO from hemoglobin in the fetus, there is a far stronger indication for HBO2 in the burned pregnant patient than in other burn patient populations.Cyanide intoxication is often a comorbid disease with CO in inhalation injury from an enclosed fire, but may be the predominant toxin. It acts synergistically with CO to effectively lower the lethal doses of both cyanide and CO. Diagnosis is best made in the presence of high lactate levels, carboxyhemoglobin concentrations greater than 10%, injury history of smoke inhalation from an enclosed fire, and alterations in consciousness. While treatment with hydroxocobalamin is the standard of care and has the effect of reducing concomitant CO toxicity, data indicate cyanide may also be displaced by HBO2.Carbon monoxide and cyanide poisoning presents potential complications impacting care. This review addresses the mechanism of action, presentation, diagnosis, and treatment of CO and cyanide poisonings in the burned pregnant patient and the use of HBO2 therapy.

show abstract

Successful Treatment of Severe Carbon Monoxide Poisoning and Refractory Shock Using Extracorporeal Membrane Oxygenation

Cited by 20 publications

References 15 publications

Extracorporeal Membrane Oxygenation for Severe Pediatric Respiratory Failure

Extracorporeal Membrane Oxygenation for Severe Pediatric Respiratory Failure

Unreliable Early Neuroprognostication After Severe Carbon Monoxide Poisoning Is Likely Due to Cytopathic Hypoxia: A Case Report and Discussion

Carbon Monoxide and Cyanide Poisoning in the Burned Pregnant Patient

Contact Info

Product

Resources

About