Acute and Critical Care

Original Articles

Meta-analysis
Comparison of safety and efficacy between therapeutic or intermediate versus prophylactic anticoagulation for thrombosis in COVID-19 patients: a systematic review and meta-analysis: Hyeon-Jeong Lee, Hye Jin Jang, Won-Il Choi, Joonsung Joh, Junghyun Kim, Jungeun Park, Miyoung Choi; Acute Crit Care. 2023;38(2):160-171. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01424; Correction in: Acute Crit Care 2023;38(4):516

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Background
Patients with coronavirus disease 2019 (COVID-19) infections often have macrovascular or microvascular thrombosis and inflammation, which are known to be associated with a poor prognosis. Heparin has been hypothesized that administration of heparin with treatment dose rather than prophylactic dose for prevention of deep vein thrombosis in COVID-19 patients. Methods: Studies comparing therapeutic or intermediate anticoagulation with prophylactic anticoagulation in COVID-19 patients were eligible. Mortality, thromboembolic events, and bleeding were the primary outcomes. PubMed, Embase, the Cochrane Library, and KMbase were searched up to July 2021. A meta-analysis was performed using random-effect model. Subgroup analysis was conducted according to disease severity. Results: Six randomized controlled trials (RCTs) with 4,678 patients and four cohort studies with 1,080 patients were included in this review. In the RCTs, the therapeutic or intermediate anticoagulation was associated with significant reductions in the occurrence of thromboembolic events (5 studies, n=4,664; relative risk [RR], 0.72; P=0.01), and a significant increase in bleeding events (5 studies, n=4,667; RR, 1.88; P=0.004). In the moderate patients, therapeutic or intermediate anticoagulation was more beneficial than prophylactic anticoagulation in terms of thromboembolic events, but showed significantly higher bleeding events. In the severe patients, the incidence of thromboembolic and bleeding events in the therapeutic or intermediate. Conclusions: The study findings suggest that prophylactic anticoagulant treatment should be used in patients with moderate and severe COVID-19 infection groups. Further studies are needed to determine more individualized anticoagulation guidance for all COVID-19 patients.

Citations

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The Community Pharmacy as a Study Center for the Epidemiological Analysis of the Population Vaccination against SARS-CoV-2: Evaluation of Vaccine Safety and Pharmaceutical Service
Jacopo Raffaele Dibenedetto, Michela Cetrone, Marina Antonacci, Domenico Pio Cannone, Stefania Antonacci, Pasquale Bratta, Francesco Leonetti, Domenico Tricarico
Pharmacy.2024; 12(1): 16. CrossRef
Specific and Non-specific Aspects and Future Challenges of ICU Care Among COVID-19 Patients with Obesity: A Narrative Review
Alexandra Beurton, Emma J. Kooistra, Audrey De Jong, Helmut Schiffl, Mercedes Jourdain, Bruno Garcia, Damien Vimpère, Samir Jaber, Peter Pickkers, Laurent Papazian
Current Obesity Reports.2024;[Epub] CrossRef

Pulmonary
Use of extracorporeal membrane oxygenation in patients with acute high-risk pulmonary embolism: a case series with literature review: You Na Oh, Dong Kyu Oh, Younsuck Koh, Chae-Man Lim, Jin-Won Huh, Jae Seung Lee, Sung-Ho Jung, Pil-Je Kang, Sang-Bum Hong; Acute Crit Care. 2019;34(2):148-154. Published online May 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00500

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Abstract PDF

Background
Although extracorporeal membrane oxygenation (ECMO) has been used for the treatment of acute high-risk pulmonary embolism (PE), there are limited reports which focus on this approach. Herein, we described our experience with ECMO in patients with acute high-risk PE.
Methods
We retrospectively reviewed medical records of patients diagnosed with acute highrisk PE and treated with ECMO between January 2014 and December 2018.
Results
Among 16 patients included, median age was 51 years (interquartile range [IQR], 38 to 71 years) and six (37.5%) were male. Cardiac arrest was occurred in 12 (75.0%) including two cases of out-of-hospital arrest. All patients underwent veno-arterial ECMO and median ECMO duration was 1.5 days (IQR, 0.0 to 4.5 days). Systemic thrombolysis and surgical embolectomy were performed in seven (43.8%) and nine (56.3%) patients, respectively including three patients (18.8%) received both treatments. Overall 30-day mortality rate was 43.8% (95% confidence interval, 23.1% to 66.8%) and 30-day mortality rates according to the treatment groups were ECMO alone (33.3%, n=3), ECMO with thrombolysis (50.0%, n=4) and ECMO with embolectomy (44.4%, n=9).
Conclusions
Despite the vigorous treatment efforts, patients with acute high-risk PE were related to substantial morbidity and mortality. We report our experience of ECMO as rescue therapy for refractory shock or cardiac arrest in patients with PE.

Citations

Citations to this article as recorded by

Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: an overview of current practice and evidence
Samir Ali, Christiaan L. Meuwese, Xavier J. R. Moors, Dirk W. Donker, Anina F. van de Koolwijk, Marcel C. G. van de Poll, Diederik Gommers, Dinis Dos Reis Miranda
Netherlands Heart Journal.2024; 32(4): 148. CrossRef
Integration of Extracorporeal Membrane Oxygenation into the Management of High-Risk Pulmonary Embolism: An Overview of Current Evidence
Romain Chopard, Raquel Morillo, Nicolas Meneveau, David Jiménez
Hämostaseologie.2024;[Epub] CrossRef
Evidence-Based Management of Massive and Submassive Pulmonary Embolism
Sara Al-Juboori, Tareq Alzaher, Hashem Al Omari, Sufyan Al Gammaz, Mazen Al-Qadi
JAP Academy Journal.2024;[Epub] CrossRef
Extracorporeal membrane oxygenation for large pulmonary emboli
Timothy J. George, Jenelle Sheasby, Rahul Sawhney, J. Michael DiMaio, Aasim Afzal, Dennis Gable, Sameh Sayfo
Baylor University Medical Center Proceedings.2023; 36(3): 314. CrossRef
Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association
Joshua B. Goldberg, Jay Giri, Taisei Kobayashi, Marc Ruel, Alexander J.C. Mittnacht, Belinda Rivera-Lebron, Abe DeAnda, John M. Moriarty, Thomas E. MacGillivray
Circulation.2023;[Epub] CrossRef
Life-threatening pulmonary embolism: overview and management
Nizar Osmani, Jonathan Marinaro, Sundeep Guliani
International Anesthesiology Clinics.2023; 61(4): 35. CrossRef
Extracorporeal Membrane Oxygenation for Pulmonary Embolism: A Systematic Review and Meta-Analysis
Jonathan Jia En Boey, Ujwal Dhundi, Ryan Ruiyang Ling, John Keong Chiew, Nicole Chui-Jiet Fong, Ying Chen, Lukas Hobohm, Priya Nair, Roberto Lorusso, Graeme MacLaren, Kollengode Ramanathan
Journal of Clinical Medicine.2023; 13(1): 64. CrossRef
Pulmonary ECMO-ism: Let’s add PEA to ECPR indications
Zachary Shinar, Alice Hutin
Resuscitation.2022; 170: 293. CrossRef
Combined use of extracorporeal membrane oxygenation with interventional surgery for acute pancreatitis with pulmonary embolism: A case report
Ling-Ling Yan, Xiu-Xiu Jin, Xiao-Dan Yan, Jin-Bang Peng, Zhuo-Ya Li, Bi-Li He
World Journal of Clinical Cases.2022; 10(12): 3899. CrossRef
Pulmonary Embolism Complicated With Cardiopulmonary Arrest Treated With Combination of Thrombolytics and Aspiration Thrombectomy
Taylor C. Remillard, Zain Kassam, Maks Coven, Aditya Mangla, Zoran Lasic
JACC: Case Reports.2022; 4(10): 576. CrossRef
Anesthetic management for intraoperative acute pulmonary embolism during inferior vena cava tumor thrombus surgery: A case report
Pei-Yu Hsu, En-Bo Wu
World Journal of Clinical Cases.2022; 10(15): 5111. CrossRef
Percutaneous mechanical thrombectomy and extracorporeal membranous oxygenation: A case series
Haytham Mously, Jamal Hajjari, Tarek Chami, Tarek Hammad, Robert Schilz, Teresa Carman, Yakov Elgudin, Yasir Abu‐Omar, Marc P. Pelletier, Mehdi H. Shishehbor, Jun Li
Catheterization and Cardiovascular Interventions.2022; 100(2): 274. CrossRef
Clinical Experiences of High-Risk Pulmonary Thromboembolism Receiving Extracorporeal Membrane Oxygenation in Single Institution
Joonyong Jang, So-My Koo, Ki-Up Kim, Yang-Ki Kim, Soo-taek Uh, Gae-Eil Jang, Wonho Chang, Bo Young Lee
Tuberculosis and Respiratory Diseases.2022; 85(3): 249. CrossRef
Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation?
Benjamin Assouline, Marie Assouline-Reinmann, Raphaël Giraud, David Levy, Ouriel Saura, Karim Bendjelid, Alain Combes, Matthieu Schmidt
Journal of Clinical Medicine.2022; 11(16): 4734. CrossRef
Optimal reperfusion strategy in acute high-risk pulmonary embolism requiring extracorporeal membrane oxygenation support: a systematic review and meta-analysis
Romain Chopard, Peter Nielsen, Fabio Ius, Serghei Cebotari, Fiona Ecarnot, Hugo Pilichowski, Matthieu Schmidt, Benedict Kjaergaard, Iago Sousa-Casasnovas, Mehrdad Ghoreishi, Rajeev L. Narayan, Su Nam Lee, Gregory Piazza, Nicolas Meneveau
European Respiratory Journal.2022; 60(5): 2102977. CrossRef
Use of extracorporeal membrane oxygenation in high‐risk acute pulmonary embolism: A systematic review and meta‐analysis
Luca Baldetti, Alessandro Beneduce, Lorenzo Cianfanelli, Giulio Falasconi, Luigi Pannone, Francesco Moroni, Angela Venuti, Stefania Sacchi, Mario Gramegna, Vittorio Pazzanese, Francesco Calvo, Guglielmo Gallone, Matteo Pagnesi, Alberto Maria Cappelletti
Artificial Organs.2021; 45(6): 569. CrossRef
Institutional Experience With Venoarterial Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism: A Retrospective Case Series
Maxwell A. Hockstein, Christina Creel-Bulos, Joshua Appelstein, Craig S. Jabaley, Michael J. Stentz
Journal of Cardiothoracic and Vascular Anesthesia.2021; 35(9): 2681. CrossRef
Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review*
John Harwood Scott, Matthew Gordon, Robert Vender, Samantha Pettigrew, Parag Desai, Nathaniel Marchetti, Albert James Mamary, Joseph Panaro, Gary Cohen, Riyaz Bashir, Vladimir Lakhter, Stephanie Roth, Huaqing Zhao, Yoshiya Toyoda, Gerard Criner, Lisa Moor
Critical Care Medicine.2021; 49(5): 760. CrossRef
Adult Langerhans histiocytosis with rare BRAF mutation complicated by massive pulmonary embolism
Salma Hassan, Christina Fanola, Amy Beckman, Faqian Li, Andrew C. Nelson, Michael Linden, Joan D. Beckman
Thrombosis Research.2020; 193: 207. CrossRef
Efficacy and safety of extracorporeal membrane oxygenation for high-risk pulmonary embolism: A systematic review and meta-analysis
Matteo Pozzi, Augustin Metge, Anthony Martelin, Caroline Giroudon, Justine Lanier Demma, Catherine Koffel, William Fornier, Pascal Chiari, Jean Luc Fellahi, Jean Francois Obadia, Xavier Armoiry
Vascular Medicine.2020; 25(5): 460. CrossRef
Evidence-Based Minireview: Advanced therapies and extracorporeal membrane oxygenation for the management of high-risk pulmonary embolism
Radhika Gangaraju, Frederikus A. Klok
Hematology.2020; 2020(1): 195. CrossRef

Case Reports

Neurosurgery
Cardiac Arrest from Patient Position Change after Spine Surgery on a Jackson Table: Boohwi Hong, Seok Hwa Yoon, Soo-Yong Park, Seunghyun Song, Ann Youn, Ja Gyung Hwang; Acute Crit Care. 2019;34(1):86-91. Published online February 20, 2017; DOI: https://doi.org/10.4266/acc.2016.00794

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Abstract PDF

The Jackson table has minimal effects on cardiac function because it does not elevate abdominal and thoracic pressures. In addition, it decreases venous congestion and increases exposure of the surgical field. However, the hips and knees are flexed with inappropriate padding, and venostasis is promoted and increased. Pulmonary thromboembolism (PTE) is fatal; thus immediate diagnosis and treatment are essential. However, clinical signs of intraoperative PTE are difficult to discern. Thrombolytic therapy can be considered as first-line therapy, but bleeding limits its use. The authors report a case of PTE resulting from patient positional change after spine surgery, and the use of immediate postoperative recombinant tissue-type plasminogen activator.

Citations

Citations to this article as recorded by

Causes of Perioperative Cardiac Arrest: Mnemonic, Classification, Monitoring, and Actions
Lingzhong Meng, Mads Rasmussen, Arnoley S. Abcejo, Deyi M. Meng, Chuanyao Tong, Hong Liu
Anesthesia & Analgesia.2023;[Epub] CrossRef
Perioperative patient positioning following scalp tumor surgery: an anesthetic challenge
Rajnish Kumar, Nishant Sahay, Shagufta Naaz, Ansarul Haq, Rajesh Kumar
Ain-Shams Journal of Anesthesiology.2022;[Epub] CrossRef
Differential diagnosis of intraoperative cardiac arrest after spine surgery in prone position
DaviBrasil Khouri, MarinaAyres Delgado, JadsonLardy Lemes, MarcelaMorais Afonso Cruz
Saudi Journal of Anaesthesia.2022; 16(4): 485. CrossRef
Pulmonary thromboembolism due to venostasis induced by sitting position during clavicle and pelvic bone fracture surgery
Soomin LEE, Boohwi HONG, Woosik HAN, Man-Shik SHIM, Yoon-Hee KIM, Seok-Hwa YOON
Chirurgia.2021;[Epub] CrossRef

Obstetric/Cardiology
Use of Extracorporeal Membrane Oxygenation in a Fulminant Course of Amniotic Fluid Embolism Syndrome Immediately after Cesarean Delivery: Jae Ha Lee, Hang Jea Jang, Jin Han Park, Yong Kyun Kim, Ho Ki Min, Sun Young Kim, Hyun-kuk Kim; Korean J Crit Care Med. 2016;31(3):256-261. Published online August 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00213

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Abstract PDF

Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.

Citations

Citations to this article as recorded by

Venoarterial Extracorporeal Membrane Oxygenation as Supportive Therapy After Cardiac Arrest After Amniotic Fluid Embolism: A Case Report
Claire Depondt, Darko Arnaudovski, Audrey Voulgaropoulos, Olivier Milleron, Walid Ghodbane, Alexy Tran Dinh, Philippe Montravers, Elie Kantor
A&A Practice.2019; 13(2): 74. CrossRef
Urgent Application of Extracorporeal Membrane Oxygenation in Amniotic Fluid Embolism
Moo Suk Park
The Korean Journal of Critical Care Medicine.2016; 31(3): 179. CrossRef

Cardiology/Pediatric
Suspected Pulmonary Embolism during Hickman Catheterization in a Child: What Else Should Be Considered besides Pulmonary Embolism?: Haemi Lee, Jonghyun Baek, Sangyoung Park, Daelim Jee; Korean J Crit Care Med. 2016;31(1):63-67. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.63

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Abstract PDF: A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.

Cardiology/Obstetric
Successful Application of Extracorporeal Membrane Oxygenation for a Patient with Clinical Amniotic Fluid Embolism: Hye Seon Kang, Hwa Young Lee, Hea Yon Lee, Seok Chan Kim; Korean J Crit Care Med. 2015;30(4):303-307. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.303

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Abstract PDF

Amniotic fluid embolism (AFE) is a rare but potentially fatal complication that occurs acutely during pregnancy or within 12 h of delivery. The management of AFE focuses initially on supportive measures for cardiopulmonary stabilization. Extracorporeal membrane oxygenation should be considered in patients who are unresponsive to medical treatment in order to prevent additional hypoxia and subsequent organ failure. We present a 41-year-old woman with clinical AFE who developed acute respiratory distress syndrome and was treated successfully with extracorporeal membrane oxygenation.

Citations

Citations to this article as recorded by

Extracorporeal Therapies for Amniotic Fluid Embolism
Julien Viau-Lapointe, Niall Filewod
Obstetrics & Gynecology.2019; 134(5): 989. CrossRef
Venous Air Embolism Not Amniotic Fluid Embolism
Charles Her
Korean Journal of Critical Care Medicine.2016; 31(1): 68. CrossRef
Urgent Application of Extracorporeal Membrane Oxygenation in Amniotic Fluid Embolism
Moo Suk Park
The Korean Journal of Critical Care Medicine.2016; 31(3): 179. CrossRef

Thoracic Surgery
Acute Peripheral Arterial Tumorous Embolism after Lung Cancer Surgery: Yoohwa Hwang, Hyun Joo Lee, Young Tae Kim; Korean J Crit Care Med. 2015;30(3):234-237. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.234

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Abstract PDF: Systemic tumor embolisms after pulmonary resections for malignancy are rare, but usually severe and sometimes fatal. Here, we report a case of a 70-year-old woman who underwent pulmonary resection for lung cancer and subsequently developed acute arterial occlusion of the lower extremities caused by a tumorous embolus.

Toxicology
Unexpected Multiple Organ Infarctions in a Poisoned Patient: Sung-Wook Park, Sang-Kyoon Han, Seok-Ran Yeom, Soon-Chang Park, Sung-Hwa Lee; Korean J Crit Care Med. 2015;30(3):227-230. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.227

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Abstract PDF: Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE). However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.

Cardiology
Thrombosis in the Left Ventricle after Implantable Cardioverter-Defibrillator Implantation: A Rare Cause of Systemic Thromboembolism: Hee Chan Jung, Woo Baek Chung, Man Young Lee; Korean J Crit Care Med. 2014;29(1):27-31. Published online February 28, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.1.27

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Abstract PDF: This report describes a case of systemic thromboembolism caused by left ventricular (LV) thrombosis that developed after placement of an implantable cardioverter-defibrillator (ICD). A 27-year-old male patient was diagnosed with idiopathic dilated cardiomyopathy and ventricular tachycardia, and underwent ICD implantation for the primary prevention of sudden cardiac death. Two weeks after ICD implantation, the patient experienced renal infarction. Transthoracic echocardiography revealed a mobile thrombus at the LV apex, and automated function imaging demonstrated deteriorated LV function after ICD implantation. The RV was not placed by ICD and the mechanical force which was occurred by ICD that led to induced dyssynchronous motion of the LV apex may have resulted in a systemic thromboembolism.

Air Embolism in the Left Ventricle after the Removal of a Central Venous Catheter: Duk Song Cho, Moo Hyun Kim, Dong Hyun Lee, Hye Won Lee, Eun Bin Kim, Seok Hyun Kim, Hyo Jin Jung, Soo Jin Kim, Hyun Jeong Kim; Korean J Crit Care Med. 2013;28(4):318-322.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.318

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Abstract PDF

Air embolism is a rare, potentially critical complication that can induce death. Central venous catheterization, which is commonly used for critically ill patients, is a possible cause of air embolism. We experienced a severe air embolism with abnormal air in left ventricle after CVC removal in a patient who was treated for eosinophilic pneumonia. Although the neurologic symptoms were severe, the patient was successfully treated with immediate hyperbaric oxygen therapy and the neurologic deficit was minimal.

Citations

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Lethal coronary air embolism caused by the removal of a double-lumen hemodialysis catheter: a case report
Sung Ha Mun, Dong Ai An, Hyun Jung Choi, Tae Hee Kim, Jung Woo Pin, Dong Chan Ko
Korean Journal of Anesthesiology.2016; 69(3): 296. CrossRef

Management of Upper Extremity Deep Vein Thrombosis with a Superior Vena Cava Filter - A Case Report -: Wooil Kwon, Ho Geol Ryu, Hannah Lee, Yongjae Yoo; Korean J Crit Care Med. 2013;28(1):59-63.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.59

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Abstract PDF: Upper extremity deep vein thrombosis (UEDVT) is relatively uncommon and superior vena cava (SVC) filter placements are not often encountered due to strict indication. A 33-year old male with underlying protein C/S deficiency and secondary liver cirrhosis was admitted because of hematemesis. The patient was conservatively managed, but underwent elective splenectomy to prevent aggravation of gastric varix. During postoperative care, the patient underwent cholecystectomy for acalculous cholecystitis. During the postoperative course, UEDVT was detected and heparinization was initiated. The patient experienced repeated attacks of severe dyspnea, which was accompanied by chest pain that lasted for 3 to 10 minutes. Repeated episodes of pulmonary thromboembolism were suspected and SVC filter was placed. Warfarin treatment was initiated and the SVC filter was removed about one month later. The case highlights the clinical significance of UEDVT and reports rare case of SVC filter placement. Intensivists should have comprehensive understanding of UEDVT and its management.

A Case of Massive Pulmonary Thromboembolism Associated with Ramsay Hunt Syndrome: A Case Report: Jong Hoo Lee, Seong Joo Koh, Gil Myeong Seong, Miok Kim, Jae Chun Lee, Sang Hoon Han, Jay Chol Choi, Yee Hyung Kim; Korean J Crit Care Med. 2011;26(4):267-271.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.267

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Abstract PDF: Ramsay Hunt syndrome associated with the Varicella zoster virus (VZV) infection is characterized by vesicles on the pinna, otalgia, facial nerve palsy and sensorineural hearing loss. Although significant complications from VZV infection are increasing, thrombosis associated with VZV infection is one of the rare complications in adults. The VZV itself could cause endothelial damage in the various organs. Subsequently, the thrombosis might be complicated. A previously healthy 84 year-old female patient was diagnosed with Ramsay Hunt syndrome. On the 7th day of antiviral treatment, she complained of sudden breathlessness. She was hypoxemic with an elevated alveolar-arterial oxygen difference and needed to be supported by mechanical ventilation. Massive pulmonary thrombosis was documented by computerized tomography and she successfully underwent thrombolytic therapy. We report a case of massive pulmonary thromboembolism associated with VZV infection, treated with thrombolytic therapy.

Acute Pulmonary Embolism Due to Free-floating Right Atrial Thrombus in a Patient with Multiple Myeloma: A Case Report: Youn Yi Jo, Yong Seon Choi, Sa Ra So, Shin Ok Koh; Korean J Crit Care Med. 2011;26(1):24-28.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.24

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Abstract PDF: Although venous thrombosis is one of the most frequent complications of malignant disease including multiple myeloma, massive pulmonary embolism is an uncommon complication. Free-floating intracardiac thrombus has been rarely reported as a cause of acute pulmonary embolism in patients with multiple myeloma. We report a case presenting acute pulmonary embolism due to free-floating right atrial thrombus in a patient with multiple myeloma.

Successful Embolectomy of a Pulmonary Saddle Embolism Post-cesarean Section Complicated by Cardiac Arrest: A Case Report: Jae Jun Lee, Jin Kim, Hyoung Soo Kim, Min Sun Kyung, Eu Sun Ro, Sung Mi Hwang, So Young Lim; Korean J Crit Care Med. 2009;24(3):164-167.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.164

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Abstract PDF: A 41-year-old female underwent an uneventful cesarean section, which was followed by a pulmonary saddle embolism complicated by cardiac arrest. This case shows that successful embolectomy is possible, despite a potentially lethal pulmonary saddle embolism, 34 cm in length, and intra-operative cardiopulmonary resuscitation. We report our case and discuss the anesthetic considerations based on the literature.

Unexpected Intra-operative Pulmonary Thromboemolism during Elective Mastoidectomy: A Case Report: Hyun Jeong Kwak, Hee Yeon Park, Hong Soon Kim, Sung Ho Choi, Kyung Cheon Lee; Korean J Crit Care Med. 2009;24(3):160-163.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.160

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Abstract PDF: We report on a 45-year-old patient who sustained an intra-operative pulmonary thromboembolism during elective mastoidectomy under general anesthesia. At the end of surgery, the patient developed hemodynamic compromise and exhibited T wave inversion on electrocardiogram. Echocardiography showed an echogenic mass in the right pulmonary artery and pulmonary hypertension. Pulmonary thromboembolism is rare in the field of otolaryngology and head and neck surgery; however, it may develop, resulting in a fatal outcome. It is thus important to establish the diagnosis early and prevent such serious complications.

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