• Journal of Yeungnam Medical Science
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• 제34권2호
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• pp.285-289
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• 2017

Pheochromocytoma can present with various symptoms including cardiogenic shock and cardiac arrest. Particularly, in cases of cardiogenic shock of unknown origin, pheochromocytoma should be considered. A 20-year-old woman without any medical history visited our emergency department due to nausea, vomiting, headache, and chest pain. Echocardiography revealed severe left ventricular dysfunction. Mechanical ventilation and veno-arterial extracorporeal membrane oxygenation (ECMO) were implemented owing to her unstable vital signs. For unstable vital sign and cardiogenic shock in a young woman without any previous medical history, pheochromocytoma was considered and diagnosed based on elevated levels of catecholamine derivatives in a 24-hour urine sample. Cardiac function recovered and ECMO was discontinued on the 5th day of hospitalization. She later underwent an elective adrenalectomy and no recurrence was found during the follow-up period. We reported a case of pheochromocytoma which was presented with cardiogenic shock in a young woman with no concomitant disease, and successfully treated with ECMO followed by an elective adrenalectomy.

• Journal of Chest Surgery
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• 제40권3호
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• pp.220-224
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• 2007

소아에서 체외막 산소화 장치는 중증호흡부전, 약물에 반응하지 않는 심부전, 패혈증, 폐동맥고혈압에서 뿐만 아니라 심장이식의 가교로서도 기계적인 심폐보조를 제공한다. 그렇지만 소아에서 부정맥에 의해 생긴 저심박출증에 대해 체외막 산소화 장치를 이용하여 심장보조를 시행한 증례는 많지 않다. 본 저자들은 부분 양심실 교정을 받은 엡스타인 기형에서 심실성 부정맥 때문에 순환 부전에 빠진 15세 여자 환자를 체외막 산소화 장치를 이용하여 치료하였기에 문헌 고찰과 함께 보고하는 바이다.

• 고신대학교 의과대학 학술지
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• 제33권2호
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• pp.215-222
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• 2018

An incidentaloma is a tumor found incidentally without clinical symptoms or suspicion; the lesion may be adrenal, pituitary, or thyroidal. We report the case of an asymptomatic individual with preoperatively undiagnosed pheochromocytoma (size: 4.86 cm) that was revealed using elective nonadrenal surgical procedures. The patient demonstrated peri- and post-operative hypertensive crisis and tachycardia. Three days after the dramatic onset of symptoms, the patient expired due to pulmonary edema, multiple organ failure, and terminal sepsis, despite administration of extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation. A left medial kidney mass obtained at autopsy confirmed pheochromocytoma.

• 대한임상독성학회지
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• 제14권1호
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• pp.1-8
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• 2016

Purpose: Extracorporeal life support (ECLS) is a term used to describe a number of modalities including extracorporeal membrane oxygenation (ECMO) to support cardiac and/or pulmonary systems. The purpose of this study is to review the available evidence regarding the effect of ECLS in patients with acute poisoning. Methods: Electronic literature searches with PubMed, Embase, Cochrane library, and KoreaMed were conducted for identification of relevant studies addressing ECLS in treatment of acute poisoning. The literature search was conducted by two investigators in March, 2016 with publication language restricted to English and Korean. The toxic substance, technique of ECLS, and final outcome of each case were analyzed. Results: The final analysis included 64 articles including 55 case reports. There were no articles classified according to a high level of evidence such as randomized trial and prospective cohort study. ECLS treatment was used in the management of patients poisoned with 36 unique substances. Venovenous ECMO was performed in 4 cases. Among the reported cases, 10 patients died despite treatment with ECLS. Conclusion: Evidence supporting ECLS for patients with acute poisoning is inadequate. However, many case reports suggest that early consideration of ECLS in poisoned patients with refractory cardiac arrest or hemodynamic compromise refractory to standard therapies may be beneficial.

• Journal of Chest Surgery
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• 제47권4호
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• pp.373-377
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• 2014

Background: This paper aimed to verify the effects of renal replacement therapy on changing the levels of serum creatinine for different veno-arterial and veno-venous configurations in prolonged extracorporeal membrane oxygenation (ECMO) patients. Methods: The subjects were chosen 71 patients who had undergone more than 1,440 minutes (24 hours) of the therapy from among 117 patients who had undergone ECMO insertion between January 2008 and December 2012. The patients were separated into the veno-arterial configuration group I (51 patients) and the veno-venous configuration group II (20 patients). The difference in the level of serum creatinine (${\Delta}Cr$) between before or just after ECMO insertion ($Cr_I$) and the level when the pump time was between 2,880 and 4,320 minutes ($Cr_F$) was checked (${\Delta}Cr=Cr_F-Cr_I$), and the average ${\Delta}Cr$ for each group was compared using a Student t-test at the confidence interval (CI) of 95%. Results: The change in the level of serum creatinine was an increase of 0.341 mg/dL (${\sigma}$=0.9202) for group I and a decrease of 0.120 mg/dL (${\sigma}$=1.5292) for group II. The change was significantly high for group I (p=0.011, CI=95%). Meanwhile, within group I, when renal replacement therapy was not done, there was a significant increase in the level of serum creatinine (p=0.009, CI=95%). Conclusion: For ECMO insertion patients whose pump time was more than 1,440 minutes, there was a significant change in the level of serum creatinine when renal replacement therapy was not done, for the veno-arterial configuration of group I.

• Journal of Nutrition and Health
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• 제54권5호
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• pp.489-500
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• 2021

본 연구는 부적절한 영양지원이 ECMO 환자의 영양상태 뿐만 아니라 사망률 등에도 부정적인 영향을 미칠 수 있음을 보여주었다. 대부분의 ECMO 환자는 중환자실 입실 초기부터 영양상태가 이미 영양불량이거나 영양불량 위험군이었고, 재원기간이 경과하면서 악화되는 것을 관찰하였다. 이는 ECMO 환자들이 가장 위중할 때에 필요로 하는 칼로리와 단백질의 영양 지원이 충분하지 않았음을 시사하는 것이며, 특히 PN과 EN의 개시 시점이 영양관리지침의 권고보다 지연되지 않도록 노력하는 개선이 시급하다. 또한, ECMO 환자의 영양상태 평가만 아니라 공급한 영양지원에 대한 환자의 반응까지 고려한 영양관리가 필요한데, 이를 위해서는 영양관리가 중환자 간호에서 우선시 되어야 하며, 영양사를 포함한 다학제간 접근이 반드시 포함되어야 한다. 점차 증가하는 ECMO 적용 사례를 고려한다면, 중환자실에서의 집중치료 과정에 영양관리도 비중있게 반영되어야 할 것이다. 차후에는 전향적 무작위통제 연구로 환자의 질환 유형이나 ECMO 배치형태에 따른 영양지원방법과 효과를 비교할 것을 제안한다. 더 많은 대상자 수 확보를 위하여 여러 병원의 자료를 취합하여 분석하거나 환자 상태에 따라 영양공급의 적정량을 평가하고 비교하는 연구를 제안한다.

• Journal of Chest Surgery
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• 제27권12호
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• pp.977-983
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• 1994

From April 1989 to December 1993, total 39 patients who were unable to be weaned off CPB or expected fatal immediate postoperiatively, were treated with ventricular assist device [VAD] or extracorporeal membrane oxygenator[ECMO] at the Royal Children`s Hospital, Melbourne. Ages ranged from 3 day to 19.4 year old and body weights from 2.0Kg to 70Kg. Twenty-seven[69.2%] of 39 patients were weaned to be decannulated successfully and sixteen[41.0%] survived to hospital discharge and late survival rate was twelve[30.8%] of 39 patients. The total follow-up period was 4 to 56 months [32.92$\pm$20.77months] and most of the late survivals showed good myocardial recovery state. From the viewpoint of the assist modality, 29 patients were treated with VAD and among them, 23 were weaned from assist successfully, but among the 8 ECMO patients, only 3 could be weaned, and both modalities were performed to the 2 patients with one weaned. The total duration of assist was from 8 to 428 hours and there was a significant difference between hospital discharged group and hospital death group, which were 83.13$\pm$31.29 hours vs 147.52$\pm$112.03 hours[P=0.032]. Conclusively, at the critical postcardiotomy situation of the paediatrtic patients including various congenital complex disease and procedures, we can choose this VAD or ECMO treatment strategy as the reasonable life saving way except transplantation.

• Journal of Chest Surgery
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• 제47권2호
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• pp.100-105
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• 2014

Background: We evaluated the safety and efficacy of percutaneous extracorporeal membrane oxygenation (ECMO) in patients with primary graft dysfunction after heart transplantation. Methods: Of 65 patients (44 males and 21 females) who underwent heart transplantation from January 2006 to December 2012, 13 patients (group I) needed peripheral ECMO support due to difficulty in weaning from cardiopulmonary bypass (CPB) and 52 patients (group II) were weaned from CPB without mechanical support. The mean age of the patients at the time of operation was $54.4{\pm}13.6$ years. There were no differences in the preoperative characteristics of the two groups. Multivariable analysis was performed to identify the risk factors for ECMO therapy. Results: All group I patients were successfully weaned from ECMO after $53{\pm}9$ hours of circulatory support. Early mortality occurred in four patients (1 [7.7%] in group I and 3 [5.8%] in group II, p>0.999). There were no differences in the postoperative complications between the two groups, with the exception of reoperation for bleeding. A greater number of group I patients underwent reoperation for bleeding (5 [38.5%] in group I vs. 6 [11.5%] in group II, p=0.035). In multivariable analysis, preoperative mechanical support (ECMO and intra-aortic balloon pump) and longer CPB time were the risk factors of ECMO therapy for graft dysfunction (odds ratio, 6.377; 95% confidence interval, 1.519 to 26.77; p=0.011 and odds ratio, 1.010; 95% confidence interval, 1.001 to 1.019; p=0.033). Conclusion: Percutaneous ECMO support could be a viable option for rescuing patients when graft dysfunction refractory to medical management develops after heart transplantation.

• Journal of Chest Surgery
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• 제44권1호
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• pp.9-17
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• 2011

Background: A peripheral extracorporeal membrane oxygenator (p-ECMO) has been developed to support patients who are dying due to a serious cardiopulmonary condition. This analysis was planned to define the clinical situation in which the patient benefits most from a p-ECMO. Material and Methods: Between June 2007 and Aug 2009, a total of 41 adult patients used the p-ECMO. There were 23 males and 18 females (mean age $54.4{\pm}15.1$ years). All patients had very unstable vital signs with hypoxia and complex cardiac problems. We divided the patients into 4 groups. In the first group, a p-ECMO was used as a bridge to cardiac operation. In the second group, patients did not have the opportunity to undergo any cardiac procedures; nevertheless, they were treated with a p-ECMO. In the third group, patients mostly had difficulty in weaning from CPB (cardiopulmonary bypass) after cardiac operation. The fourth group suffered from many complications, such as pneumonia, bleeding, infections, and LV dysfunction with underlying cardiac problems. All cannulations were performed by the Seldinger technique or cutting down the femoral vessel. A long venous cannula of $DLP^{(R)}$ (Medtronic Inc, Minneapolis, MN) or $RMI^{(R)}$ (Edwards Lifesciences LLC, Irvine, CA) was used together with a 17~21 Fr arterial cannula and a 21 Fr venous cannula. As a bypass pump, a Capiox emergency bypass system ($EBS^{(R)}$; Terumo, Tokyo, Japan) was used. We attempted to maintain a flow rate of $2.4{\sim}3.0\;L/min/m^2$ and an activated clotting time (ACT) of around 180 seconds. Results: Nine patients survived by the use of the p-ECMO. Ten patients were weaned from a p-ECMO but they did not survive, and the remainder had no chance to be weaned from the p-ECMO. The best clinical situation to apply the p-ECMO was to use it as a bridge to cardiac operation and for weaning from CPB after cardiac operation. Conclusion: Various clinical results were derived by p-ECMO according to the clinical situation. For the best results, early adoption of the p-ECMO for anatomical correction appears important.

• Clinical and Experimental Pediatrics
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• 제57권11호
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• pp.489-495
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• 2014

Purpose: The aims of this study were to document our single-center experience with pediatric acute fulminant myocarditis (AFM) and to investigate its clinical features and short-term outcomes. Methods: We performed a retrospective chart review of all children <18 years old who were diagnosed with AFM between October 2008 and February 2013. Data about patient demographics, initial symptoms, investigation results, management, and outcomes between survivors and nonsurvivors were collected. Results: Seventeen of 21 patients (80.9%) with myocarditis were diagnosed with AFM. Eleven patients (64.7%) survived to discharge, and 6 (35.3%) died. Electrocardiography on admission revealed dysrhythmia in 10 patients (58.8%); of these, all 7 patients with a complete atrioventricular block survived. Fractional shortening upon admission was significantly different between the survivors (16%) and nonsurvivors (8.5%) (P=0.01). Of the serial biochemical markers, only the initial brain natriuretic peptide (P=0.03) and peak blood urea nitrogen levels (P=0.02) were significantly different. Of 17 patients, 4 (23.5%) required medical treatment only. Extracorporeal membrane oxygenation (ECMO) was performed in 13 patients (76.5%); the survival rate in these patients was 53.8%. ECMO support was initiated >24 hours after admission in 4 of the 13 patients (30.7%), and 3 of those 4 patients (75%) died. Conclusion: AFM outcomes may be associated with complete atrioventricular block upon hospital admission, left ventricular fractional shortening at admission, time from admission to the initiation of ECMO support, initial brain natriuretic peptide level, and peak blood urea nitrogen level.