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Rufener CR, Friedman NA, Vaught JE, Harvey HA, Coufal NG. Utilizing extracorporeal membrane oxygenation and surfactant in the management of severe acute respiratory distress syndrome due to hydrocarbon pneumonitis. Perfusion 2024; 39:615-619. [PMID: 36548345 PMCID: PMC10943606 DOI: 10.1177/02676591221148605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Severe cases of hydrocarbon aspiration requiring Extracorporeal Membrane Oxygenation (ECMO) are rarely reported in pediatrics, and 90% of hospitalized patients have a relatively benign clinical course. We describe a 14 month-old female with accidental hydrocarbon ingestion and aspiration due to organic makeup brush cleaner that suffered severe ARDS and multiorgan failure, successfully managed with ECMO and surfactant. She was decannulated after a total of 72 hours on ECMO, extubated on hospital day 15 (HD 15), and discharged home in her normal state of health after one month in the hospital. ECMO and adjunctive therapies such as surfactant may be helpful in the management of severe hydrocarbon pneumonitis and there are limited reports of ECMO as a supportive method for these pediatric patients.
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Affiliation(s)
- Christina R Rufener
- Department of Pediatrics, University of California at San Diego, La Jolla, CA, USA
- Rady Children’s Hospital San Diego, San Diego, CA, USA
| | - Nathan A Friedman
- Rady Children’s Hospital San Diego, San Diego, CA, USA
- Department of Emergency Medicine, Division of Medical Toxicology, University of California, San Diego, CA, USA
| | - Jordan E Vaught
- Department of Pediatrics, University of California at San Diego, La Jolla, CA, USA
- Rady Children’s Hospital San Diego, San Diego, CA, USA
| | - Helen A Harvey
- Department of Pediatrics, University of California at San Diego, La Jolla, CA, USA
- Rady Children’s Hospital San Diego, San Diego, CA, USA
| | - Nicole G Coufal
- Department of Pediatrics, University of California at San Diego, La Jolla, CA, USA
- Rady Children’s Hospital San Diego, San Diego, CA, USA
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Chao CCJ, Ronco J. A case report of recreational use of inhaled Freon leading to acute hypoxemic respiratory failure salvaged by veno-venous extracorporeal membrane oxygenation. Can J Anaesth 2022; 69:1300-1304. [PMID: 35882725 PMCID: PMC9323881 DOI: 10.1007/s12630-022-02296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 04/13/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Freon™ is a halogenated hydrocarbon often used as a refrigerant. When inhaled recreationally, it has the desired effects of euphoria and intoxication. Toxic effects include cardiovascular and neurologic insults such as arrhythmias and seizures, and less well-described toxicities include airway and lung injury. The treatment in general is primarily supportive. CLINICAL FEATURES We present the case of a 42-yr-old previously healthy male who developed acute bronchiolitis and pneumonitis following inhalation of Freon leading to severe respiratory failure. He was supported by veno-venous extracorporeal membrane oxygenation and managed with high-dose corticosteroids. CONCLUSION To our knowledge, this is the first case report of an inhaled Freon exposure resulting in acute lung injury refractory to conventional therapy that was salvaged by vv-ECMO as a bridge towards a full recovery.
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Affiliation(s)
- Chung-Chi Jennifer Chao
- Division of Critical Care, Department of Medicine, The University of British Columbia, 855 West 12th Ave, Vancouver, BC, V5Z 1M9, Canada.
| | - Juan Ronco
- Division of Critical Care, Department of Medicine, The University of British Columbia, 855 West 12th Ave, Vancouver, BC, V5Z 1M9, Canada
- Intensive Care Unit, Vancouver General Hospital, Vancouver, BC, Canada
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Tonna JE, Barbaro RP, Rycus PT, Wall N, Raman L, Nasr VG, Paden ML, Thiagarajan RR, Dalton H, Conrad SA, Bartlett RH, Toomasian JM, Alexander PMA. On the Academic Value of 30 Years of the Extracorporeal Life Support Organization Registry. ASAIO J 2021; 67:1-3. [PMID: 33196480 PMCID: PMC7748999 DOI: 10.1097/mat.0000000000001318] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Joseph E Tonna
- From the Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
- Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Ryan P Barbaro
- Department of Pediatrics, University of Michigan, Ann Arbor; Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Peter T Rycus
- Extracorporeal Life Support Organization, Ann Arbor, Michigan
| | - Natalie Wall
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Lakshmi Raman
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Viviane G Nasr
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matt L Paden
- Division of Pediatric Critical Care, Emory University, Atlanta, Georgia
| | - Ravi R Thiagarajan
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Steven A Conrad
- Departments of Medicine, Emergency Medicine and Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
| | | | - John M Toomasian
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Peta M A Alexander
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Lewis J, Zarate M, Tran S, Albertson T. The Recommendation and Use of Extracorporeal Membrane Oxygenation (ECMO) in Cases Reported to the California Poison Control System. J Med Toxicol 2019; 15:169-177. [PMID: 30895517 DOI: 10.1007/s13181-019-00704-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Antidotes are available to treat some specific poisonings; however, the mainstay of treatment for the poisoned patient remains supportive care. Extracorporeal membrane oxygenation (ECMO) is one of the most aggressive supportive measures available to manage poisoned patients. OBJECTIVE To characterize the recommendation and use of ECMO in cases reported to the California Poison Control System (CPCS). METHODS This retrospective chart review queried the CPCS database from 1997 to 2016 for cases containing the American Association of Poison Control Centers (AAPCC) code for ECMO, and "ECMO" and "ECLS" free-text searches. The collected data included year, age, gender, substances involved, route of exposure, clinical effects, treatments, and medical outcome. RESULTS A total of 94 cases discussed ECMO as a supportive option with 16 cases utilizing ECMO. Cases where ECMO was discussed rose from one case in 1997 to 13 cases in 2016. Of the 94 cases where ECMO was discussed, 38 cases (40%) involved toxicity from a cardiovascular agent(s) and 33 cases (35%) involved exposure to hydrocarbons. Of the 16 cases where ECMO was performed, 13 (81%) involved males. The median age was 17 years (range 1 month-54 years). Ten cases (63%) involve patients under the age of 18. In this series, 13 of 16 ECMO-supported patients survived (81%). CONCLUSIONS ECMO is being recommended more often for treatment of acute poisoning cases by the CPCS. All caregivers involved in the treatment of poisoning should gain a working knowledge of the potentially lifesaving technology of ECMO, its indications for use, adverse effects, and drug or poison interactions.
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Affiliation(s)
- Justin Lewis
- California Poison Control System (CPCS), Sacramento Division, 2450 48th St. ASB 1260, Sacramento, CA, 95817, USA.
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA.
- School of Medicine, University of California Davis, Sacramento, CA, USA.
| | - M Zarate
- California Poison Control System (CPCS), Sacramento Division, 2450 48th St. ASB 1260, Sacramento, CA, 95817, USA
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - S Tran
- California Poison Control System (CPCS), Sacramento Division, 2450 48th St. ASB 1260, Sacramento, CA, 95817, USA
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - T Albertson
- California Poison Control System (CPCS), Sacramento Division, 2450 48th St. ASB 1260, Sacramento, CA, 95817, USA
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
- School of Medicine, University of California Davis, Sacramento, CA, USA
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Maheshwari A, Gulati S. Kerosene poisoning. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2018. [DOI: 10.1016/j.injms.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hughes A, Johnson NJ, Mazor SS. Extracorporeal Life Support: Indications and Use in Severely Poisoned Patients. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017. [DOI: 10.1016/j.cpem.2017.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Wang GS, Levitan R, Wiegand TJ, Lowry J, Schult RF, Yin S. Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC). J Med Toxicol 2016; 12:95-9. [PMID: 26013746 DOI: 10.1007/s13181-015-0486-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Although there have been many developments related to specific strategies for treating patients after poisoning exposures, the mainstay of therapy remains symptomatic and supportive care. One of the most aggressive supportive modalities is extracorporeal membrane oxygenation (ECMO). Our goal was to describe the use of ECMO for toxicological exposures reported to the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC). We performed a retrospective review of the ACMT ToxIC Registry from January 1, 2010 to December 31, 2013. Inclusion criteria included patients aged 0 to 89 years, evaluated between January 2010 through December 2013, and received ECMO for toxicological exposure. There were 26,271 exposures (60 % female) reported to the ToxIC Registry, 10 (0.0004 %) received ECMO: 4 pediatric (< 12 years), 2 adolescent (12-18 years), and 4 adults (>18 years). Time of initiation of ECMO ranged from 4 h to 4 days, with duration from 15 h to 12 days. Exposures included carbon monoxide/smoke inhalation (2), bitter almonds, methanol, and several medications including antihistamines (2), antipsychotic/antidepressant (2), cardiovascular drugs (2), analgesics (2), sedative/hypnotics (2), and antidiabetics (2). Four ECMO patients received cardiopulmonary resuscitation (CPR) during their hospital course, and the overall survival rate was 80 %. ECMO was rarely used for poisoning exposures in the ACMT ToxIC Registry. ECMO was utilized for a variety of ages and for pharmaceutical and non-pharmaceutical exposures. In most cases, ECMO was administered prior to cardiovascular failure, and survival rate was high. If available, ECMO may be a valid treatment modality.
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Affiliation(s)
- G S Wang
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, 13123 E 16th Ave B251, Aurora, CO, 80045, USA. .,Rocky Mountain Poison and Drug Center, Denver Health Hospital, Denver, CO, USA.
| | - R Levitan
- Department of Emergency Medicine and Medical Toxicology, University of Arizona, Banner Good Samarian Medical Center, Phoenix, AZ, USA
| | - T J Wiegand
- Department of Emergency Medicine, University of Rochester Medicine, Rochester, NY, USA
| | - J Lowry
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO, USA
| | - R F Schult
- Department of Emergency Medicine, University of Rochester Medicine, Rochester, NY, USA.,Department of Pharmacy, University of Rochester Medicine, Rochester, NY, USA
| | - S Yin
- Cincinnati Drug and Poison Information Center, Cincinnati, OH, USA
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Makrygianni EA, Palamidou F, Kaditis AG. Respiratory complications following hydrocarbon aspiration in children. Pediatr Pulmonol 2016; 51:560-9. [PMID: 26910771 DOI: 10.1002/ppul.23392] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 01/08/2016] [Accepted: 01/13/2016] [Indexed: 11/12/2022]
Abstract
Accidental hydrocarbon ingestion may lead to aspiration and chemical pneumonitis in children. In this review article, the clinical course of hydrocarbon pneumonitis, chest radiographic abnormalities, complications, and treatment interventions are summarized. Most children remain asymptomatic and without complications following ingestion of a hydrocarbon. In approximately 15% of ingestions, aspiration pneumonitis occurs and evolves over the first 6-8 hr presenting with fever, tachypnea, hypoxemia, and tachycardia. A symptom zenith is reached within 48 hr followed by progressive improvement. Up to 5% of pneumonitis cases progress rapidly to acute respiratory failure. Chest radiographic abnormalities develop by 4-8 hr after ingestion, but they are not always predictive of clinical pneumonitis. Patients with history of hydrocarbon ingestion should be monitored for 6-8 hr in the emergency department and a chest radiogram should be obtained at the end of the observation period. Spontaneous or induced emesis and gastric lavage have been related to aspiration pneumonitis. Children who are symptomatic are admitted to the hospital for cardiorespiratory status monitoring and supportive care. Approximately 90% of hospitalized patients have a benign clinical course. Increased work of breathing with or without altered sensorium and seizures are indications for admission to the intensive care unit. Hypoxemia unresponsive to supplemental oxygen and/or severe central nervous system involvement require mechanical ventilation. Corticosteroids do not seem to offer any benefit and antibiotics are administered in cases of bacterial superinfection. Pneumatoceles may become evident after the first 6-10 days of symptoms on follow-up chest radiograms and they resolve up to 6 months later. Pediatr Pulmonol. 2016;51:560-569. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Evanthia A Makrygianni
- Pediatric Pulmonology Unit, First Department of Pediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Fani Palamidou
- Pediatric Pulmonology Unit, First Department of Pediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Athanasios G Kaditis
- Pediatric Pulmonology Unit, First Department of Pediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
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Ouellet G, Bouchard J, Ghannoum M, Decker BS. Available extracorporeal treatments for poisoning: overview and limitations. Semin Dial 2014; 27:342-9. [PMID: 24697909 DOI: 10.1111/sdi.12238] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Poisoning is a significant public health problem. In severe cases, extracorporeal treatments (ECTRs) may be required to prevent or reverse major toxicity. Available ECTRs include intermittent hemodialysis, sustained low-efficiency dialysis, intermittent hemofiltration and hemodiafiltration, continuous renal replacement therapy, hemoperfusion, therapeutic plasma exchange, exchange transfusion, peritoneal dialysis, albumin dialysis, cerebrospinal fluid exchange, and extracorporeal life support. The aim of this article was to provide an overview of the technical aspects, as well as the potential indications and limitations of the different ECTRs used for poisoned patients.
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Affiliation(s)
- Georges Ouellet
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Quebec, Canada
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de Lange DW, Sikma MA, Meulenbelt J. Extracorporeal membrane oxygenation in the treatment of poisoned patients. Clin Toxicol (Phila) 2013; 51:385-93. [DOI: 10.3109/15563650.2013.800876] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kamijo Y, Soma K, Asari Y, Ohwada T. Pulse steroid therapy in adult respiratory distress syndrome following petroleum naphtha ingestion. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 2000; 38:59-62. [PMID: 10696927 DOI: 10.1081/clt-100100918] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
CASE REPORT A suicide attempt by a 23-year-old woman involved ingestion of 1000 mL of petroleum naphtha. Early chemical pneumonitis was complicated by life-threatening, diffuse interstitial lung consolidation with pneumatoceles. Pulse steroid therapy beginning on day 17 was associated with remarkable resolution of interstitial consolidation, although an enlarging secondarily infected pneumatocele ruptured to produce a bronchopleural fistula. Thoracic surgery and antibiotic therapy resulted in improvement of the patient's respiratory condition, and she was discharged with no residual respiratory symptoms. High-dose corticosteroid therapy appears to be a useful addition to aggressive supportive treatment in late adult respiratory distress syndrome following hydrocarbon ingestion.
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Affiliation(s)
- Y Kamijo
- Department of Emergency and Critical Care Medicine, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan.
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