급성 중독에서 체외순환보조장치의 적용
Extracorporeal Life Support in Acute Poisoning
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참고문헌
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초록
Purpose: Cardiovascular or respiratory complications of acute intoxication are the most common causes of mortality. Advanced cardiac life support (ACLS) or specific antidotes help manage these cardiac or respiratory complications in acute intoxication. On the other hand, some cases do not respond to ACLS or antidotes and they require some special treatment, such as extracorporeal life support (ECLS). ECLS will provide the chance of recovery from acute intoxication. This study examined the optimal timing of ECLS in acute intoxication cases. Methods: This paper is a brief report of a case series about ECLS in acute poisoning. The cases of ECLS were reviewed and the effects of ECLS on the blood pressure and serum lactate level of the patients were analyzed. Results: A total of four cases were reviewed; three of them were antihypertensive agent-induced shock, and one was respiratory failure after the inhalation of acid. The time range of ECLS application was 4.8-23.5 hours after toxic exposure. The causes of ECLS implementation were one for recurrent cardiac arrest, two for shock that did not respond to ACLS, and one for respiratory failure that did not respond to mechanical ventilator support. Three patients showed an improvement in blood pressure and serum lactate level and were discharged alive. In case 1, ECLS was stared at 23.5 hours post toxic exposure; the patient died due to refractory shock and multiple organ failure. Conclusion: The specific management of ECLS should be considered when a patient with acute intoxication does not recovery from shock or respiratory failure despite ACLS, antidote therapies, or mechanical ventilator support. ECLS improved the hemodynamic and ventilator condition in complicated poisoned patients. The early application of ECLS may improve the tissue perfusion state and outcomes of these patients before the toxic damage becomes irreversible.
Abstract
Purpose: Cardiovascular or respiratory complications of acute intoxication are the most common causes of mortality. Advanced cardiac life support (ACLS) or specific antidotes help manage these cardiac or respiratory complications in acute intoxication. On the other hand, some cases do not respond to ACLS or antidotes and they require some special treatment, such as extracorporeal life support (ECLS). ECLS will provide the chance of recovery from acute intoxication. This study examined the optimal timing of ECLS in acute intoxication cases. Methods: This paper is a brief report of a case series about ECLS in acute poisoning. The cases of ECLS were reviewed and the effects of ECLS on the blood pressure and serum lactate level of the patients were analyzed. Results: A total of four cases were reviewed; three of them were antihypertensive agent-induced shock, and one was respiratory failure after the inhalation of acid. The time range of ECLS application was 4.8-23.5 hours after toxic exposure. The causes of ECLS implementation were one for recurrent cardiac arrest, two for shock that did not respond to ACLS, and one for respiratory failure that did not respond to mechanical ventilator support. Three patients showed an improvement in blood pressure and serum lactate level and were discharged alive. In case 1, ECLS was stared at 23.5 hours post toxic exposure; the patient died due to refractory shock and multiple organ failure. Conclusion: The specific management of ECLS should be considered when a patient with acute intoxication does not recovery from shock or respiratory failure despite ACLS, antidote therapies, or mechanical ventilator support. ECLS improved the hemodynamic and ventilator condition in complicated poisoned patients. The early application of ECLS may improve the tissue perfusion state and outcomes of these patients before the toxic damage becomes irreversible.
참고문헌 (12)
- Manini AF, "Incidence of adverse cardiovascular events in adults following drug overdose", Acad Emerg Med, 19, pp.843~849 (2012)
- Reynolds JC, "Duration of Resuscitation Efforts and Functional Outcome After Out-of-Hospital Cardiac Arrest: When Should We Change to Novel Therapies?", Circulation, 128, pp.2488~2494 (2013)
- Kim SJ, "Comparing extracorporeal cardiopulmonary resuscitation with conventional cardiopulmonary resuscitation: A meta-analysis", Resuscitation, 103, pp.106~116 (2016)
- Megarbanel B, "Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest", Intensive Care Med, 33, pp.758~764 (2007)
- Daubin C, "Extracorporeal life support in severe drug intoxication:a retrospective cohort study of seventeen cases", Critical Care, 13, pp.R138~ (2009)
- Shin JS, "Successful extracorporeal life support after potentially fatal pulmonary oedema caused by inhalation of nitric acid and hydrofluoric acid fumes", Resuscitation, 75, pp.184~188 (2007)
- Labarinas S, "Extracorporeal cardiopulmonary resuscitation after diphenhydramine ingestion", J Med Tox, 14, pp.253~256 (2018)
- Kim SJ, "An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest : A propensitymatched study", Critical Care, 18, pp.1~15 (2014)
- Brooks SC, "Part 6: Alternative Techniques and Ancillary Devices for Cardiopulmonary Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care", Circulation, 132, pp.S436~S443 (2015)
- Lim CH, "Comparison of coronary artery blood flow and hemodynamic energy in a pulsatile pump versus a combined nonpulsatile pump and an intra-aortic balloon pump", ASAIO J, 52, pp.595~597 (2006)
- Koicz J, "Extracorporeal life support in severe propranolol and verapamil intoxication", J Intensive Care Med, 22, pp.381~385 (2007)
- Thiagarajan RR, "Extracorporeal life support organization registry International report 2016", ASAIO Journal, 63, pp.60~67 (2017)