Acute and Critical Care

Jae Ha Lee

4 Articles

Pulmonary
The role of nafamostat mesilate as a regional anticoagulant during extracorporeal membrane oxygenation: Jae Ha Lee, Jin Han Park, Ji Hoon Jang, Se Hun Kim, Sung Yong Hong, Woon Heo, Dong-Hwan Lee, Hye Sook Choi, Ki Hoon Kim, Hang-Jea Jang; Acute Crit Care. 2022;37(2):177-184. Published online April 20, 2022; DOI: https://doi.org/10.4266/acc.2021.01312

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Background
Anticoagulation during extracorporeal membrane oxygenation (ECMO) usually is required to prevent thrombosis. The aim of this study was to investigate the usefulness of nafamostat mesilate (NM) as a regional anticoagulant during veno-arterial ECMO (VA-ECMO) treatment. Methods: We retrospectively reviewed the medical records of 16 patients receiving VA-ECMO and NM from January 2017 to June 2020 at Haeundae Paik Hospital. We compared clinical and laboratory data, including activated partial thromboplastin time (aPTT), which was measured simultaneously in patients and the ECMO site, to estimate the efficacy of regional anticoagulation. Results: The median patient age was 68.5 years, and 56.3% of patients were men. Cardiovascular disease was the most common primary disease (75.0%) requiring ECMO treatment, followed by respiratory disease (12.5%). The median duration of ECMO treatment was 7.5 days. Among 16 patients, seven were switched to NM after first using heparin as an anticoagulation agent, and nine received only NM. When comparing aPTT values in the NM group between patients and the ECMO site, that in patients was significantly lower than that at the ECMO site (73.57 vs. 79.25 seconds; P=0.010); in contrast, no difference was observed in the heparin group. Conclusions: NM showed efficacy as a regional anticoagulation method by sustaining a lower aPTT value compared to that measured at the ECMO site. NM should be considered as a safer regional anticoagulation method in VA-ECMO for patients at high risk of bleeding.

Citations

Citations to this article as recorded by

Approach to Decompensated Right Heart Failure in the Acute Setting
Catherine V. Levitt, Caitlin A. Williams, Jalil Ahari, Ali Pourmand
Journal of Clinical Medicine.2024; 13(3): 869. CrossRef
Critical Care Management of Severe Asthma Exacerbations
Shameek Gayen, Stephen Dachert, Bilal Lashari, Matthew Gordon, Parag Desai, Gerard Criner, Juan Cardet, Kartik Shenoy
Journal of Clinical Medicine.2024; 13(3): 859. CrossRef
Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic Shock
Jan-Sören Padberg, Jannik Feld, Leonie Padberg, Jeanette Köppe, Lena Makowski, Joachim Gerß, Patrik Dröge, Thomas Ruhnke, Christian Günster, Stefan Andreas Lange, Holger Reinecke
Journal of Clinical Medicine.2024; 13(4): 1167. CrossRef
Extra-Corporeal Membrane Oxygenation in Pregnancy
Tatsiana Romenskaya, Yaroslava Longhitano, Aman Mahajan, Gabriele Savioli, Antonio Voza, Manfredi Tesauro, Christian Zanza
Journal of Clinical Medicine.2024; 13(6): 1634. CrossRef
Anticoagulants in adult extracorporeal membrane oxygenation: alternatives to standardized anticoagulation with unfractionated heparin
Shu Tang, Liqing Xu, Hui Li, Zhanshen Wu, Qiang Wen
European Journal of Clinical Pharmacology.2023; 79(12): 1583. CrossRef
Management of cardiopulmonary bypass in patients with ischemic and hemorrhagic strokes in surgery for active infective endocarditis
Takahiro Yamazato, Hiroshi Munakata, Yutaka Okita
Indian Journal of Thoracic and Cardiovascular Surgery.2023;[Epub] CrossRef

Pulmonary
The effects of direct hemoperfusion with polymyxin B-immobilized fiber in patients with acute exacerbation of interstitial lung disease: Jae Ha Lee, Jin Han Park, Hyo-Jung Kim, Hyun Kuk Kim, Ji Hoon Jang, Yong Kyun Kim, Bong Soo Park, Si Hyung Park, Il Hwan Kim, Se Hun Kim, Woon Heo, Hang-Jea Jang; Acute Crit Care. 2021;36(2):126-132. Published online April 15, 2021; DOI: https://doi.org/10.4266/acc.2021.00073

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Abstract PDF

Background
Acute exacerbation of interstitial lung disease (AE-ILD) causes clinically significant deterioration and has an extremely poor prognosis with high mortality. Recently, several studies reported the effectiveness of direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) in patients with AE-ILD as a potential therapy. This study describes the clinical effectiveness and safety of PMX-DHP in patients with AE-ILD.
Methods
We retrospectively reviewed the medical records of 10 patients (11 episodes) with AE-ILD treated with PMX-DHP from January 2018 to June 2019. We compared laboratory and physiologic data of the ratio of partial pressure arterial oxygen to fraction of inspired oxygen (P/F ratio) and level of inflammatory markers before and after implementation of PMX-DHP.
Results
Ten patients were included according to the 2016 revised definition of acute exacerbation of idiopathic pulmonary fibrosis (IPF). Nine patients had IPF and one patient had fibrotic nonspecific interstitial pneumonia. Most patients (90.9%) were treated with a steroid pulse, and four patients (36.4%) were treated with an immunosuppressant. The median number of PMX-DHP cycles was 2, and the median duration of each cycle was 6 hours. After PMX-DHP, the mean P/F ratio improved (86 [range, 63–106] vs. 145 [86–260], P=0.030) and interleukin-6 and c-reactive protein decreased (79 [35–640] vs. 10 [5–25], P=0.018 and 14 [4–21] vs. 5 [2–6], P=0.019, respectively). The 30-day mortality rate was 27.3% and the 90-day mortality rate was 72.7%.
Conclusions
PMX-DHP treatment improved P/F ratio and reduced inflammatory markers in AE-ILD patients.

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Polymyxin B-immobilised fibre column treatment for acute exacerbation of idiopathic pulmonary fibrosis patients with mechanical ventilation: a nationwide observational study
Nobuyasu Awano, Taisuke Jo, Takehiro Izumo, Minoru Inomata, Yu Ito, Kojiro Morita, Hiroki Matsui, Kiyohide Fushimi, Hirokazu Urushiyama, Takahide Nagase, Hideo Yasunaga
Journal of Intensive Care.2023;[Epub] CrossRef
Changes in Oxygenation and Serological Markers in Acute Exacerbation of Interstitial Lung Disease Treated with Polymyxin B Hemoperfusion
Song-I Lee, Chaeuk Chung, Dongil Park, Da Hyun Kang, Jeong Eun Lee
Journal of Clinical Medicine.2022; 11(9): 2485. CrossRef

Pulmonary
Direct hemoperfusion with polymyxin B-immobilized fiber column in a patient with acute exacerbation of idiopathic pulmonary fibrosis: Shin Young Kim, Jin Han Park, Hyo Jung Kim, Hang Jea Jang, Hyun Kuk Kim, Seung Hoon Kim, Jae Ha Lee; Acute Crit Care. 2020;35(4):302-306. Published online April 13, 2020; DOI: https://doi.org/10.4266/acc.2020.00038

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Abstract PDF: Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease characterized by dyspnea and a worsening of the lung function. Acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF) are defined by a clinically significant respiratory deterioration, that typically develops in less than 1 month, accompanied by new radiologic abnormalities on high-resolution computed tomography, including diffused and bilateral ground-glass opacification, along with an absence of other obvious clinical etiologies. Recently, AE-IPF has gained significant importance as a major cause of mortality and morbidity. However, despite the extremely poor prognosis of the condition, no well-validated therapeutic interventions are currently available. Therefore, novel treatment modalities are being investigated and applied in addition to conventional treatments. Among them, several studies have reported that a direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP), developed for endotoxin removal in septic shock, has an effect on AE-IPF. We describe two cases of PMX-DHP treatment with conflicting results. One patient successfully recovered via a PMX-DHP in severe AE-IPF that required extracorporeal membrane oxygenation (ECMO). PMX-DHP subsequently improved oxygenation (PaO2/FiO2 ratio) and decreased the levels of inflammatory markers (interleukin-6, C-reactive protein, and white blood cells). The patient dramatically recovered without the need for ECMO. PMX-DHP may be considered an alternative therapy in AE-IPF patients requiring mechanical ventilation or ECMO.

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

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