BACKGROUND Most species of aconite contain highly toxic aconitines,the oral ingestion of which can be fatal,primarily because they cause ventricular arrhythmias.We describe a case of severe aconite poisoning that was ...BACKGROUND Most species of aconite contain highly toxic aconitines,the oral ingestion of which can be fatal,primarily because they cause ventricular arrhythmias.We describe a case of severe aconite poisoning that was successfully treated through venoarterial extracorporeal membrane oxygenation(VA-ECMO)and in which detailed toxicological analyses of the aconite roots and biological samples were performed using liquid chromatography-tandem mass spectrometry(LC-MS/MS).CASE SUMMARY A 23-year-old male presented to the emergency room with circulatory collapse and ventricular arrhythmia after ingesting approximately half of a root labeled,“Aconitum japonicum Thunb”.Two hours after arrival,VA-ECMO was initiated as circulatory collapse became refractory to antiarrhythmics and vasopressors.Nine hours after arrival,an electrocardiogram revealed a return to sinus rhythm.The patient was weaned off VA-ECMO and the ventilator on hospital days 3 and 5,respectively.On hospital day 15,he was transferred to a psychiatric hospital.The other half of the root and his biological samples were toxicologically analyzed using LC-MS/MS,revealing 244.3 mg/kg of aconitine and 24.7 mg/kg of mesaconitine in the root.Serum on admission contained 1.50 ng/mL of aconitine.Beyond hospital day 2,neither were detected.Urine on admission showed 149.09 ng/mL of aconitine and 3.59 ng/mL of mesaconitine,but these rapidly decreased after hospital day 3.CONCLUSION The key to saving the life of a patient with severe aconite poisoning is to introduce VA-ECMO as soon as possible.展开更多
BACKGROUND Venous air embolism(VAE)is a potentially lethal condition,with a reported incidence rate of about 0.13%,and the true incidence may be higher since many VAE are asymptomatic.The current treatments for VAE in...BACKGROUND Venous air embolism(VAE)is a potentially lethal condition,with a reported incidence rate of about 0.13%,and the true incidence may be higher since many VAE are asymptomatic.The current treatments for VAE include Durant's maneuver,aspiration and removal of air through venous catheters,and hyperbaric oxygen therapy.For critically ill patients,use of cardiotonic drugs and chest compressions remain useful strategies.The wider availability of extracorporeal membrane oxygenation(ECMO)has brought a new option for VAE patients.CASE SUMMARY A 53-year-old female patient with VAE presented to the emergency clinic due to abdominal pain with fever for 1 d and unconsciousness for 2 h.One day ago,the patient suffered from abdominal pain,fever,and diarrhea.She suddenly became unconscious after going to the toilet during the intravenous infusion of ciprofloxacin 2 h ago,accompanied by nausea and vomiting,during which a small amount of gastric contents were discharged.She was immediately sent to a local hospital,where cranial and chest computed tomography showed bilateral pneumonia as well as accumulated air visible in the right ventricle and pulmonary artery.The condition deteriorated despite endotracheal intubation,rehydration,and other treatments,and the patient was then transferred to our hospital.Veno-arterial ECMO was applied in our hospital,and the patient's condition gradually improved.The patient was successfully weaned from ECMO and extubated after two days.CONCLUSION ECMO may be an important treatment for patients with VAE in critical condition.展开更多
BACKGROUND Aconitine poisoning is highly prone to causing malignant arrhythmias.The elimination of aconitine from the body takes a considerable amount of time,and during this period,patients are at a significant risk ...BACKGROUND Aconitine poisoning is highly prone to causing malignant arrhythmias.The elimination of aconitine from the body takes a considerable amount of time,and during this period,patients are at a significant risk of death due to malignant arrhythmias associated with aconitine poisoning.CASE SUMMARY A 30-year-old male patient was admitted due to accidental ingestion of aconitinecontaining drugs.Upon arrival at the emergency department,the patient intermittently experienced malignant arrhythmias including ventricular tachycardia,ventricular fibrillation,ventricular premature beats,and cardiac arrest.Emergency interventions such as cardiopulmonary resuscitation and defibrillation were promptly administered.Additionally,veno-arterial extracorporeal membrane oxygenation(VA-ECMO)therapy was initiated.Successful resuscitation was achieved before ECMO placement,but upon initiation of ECMO,the patient experienced recurrent malignant arrhythmias.ECMO was utilized to maintain hemodynamics and respiration,while continuous blood purification therapy for toxin clearance,mechanical ventilation,and hypothermic brain protection therapy were concurrently administered.On the third day of VA-ECMO support,the patient’s respiratory and hemodynamic status stabilized,with only frequent ventricular premature beats observed on electrocardiographic monitoring,and echocardiography indicated recovery of cardiac contractile function.On the fourth day,a significant reduction in toxin levels was observed,along with stable hemodynamic and respiratory functions.Following a successful pump-controlled retrograde trial occlusion test,ECMO assistance was terminated.The patient gradually improved postoperatively and achieved recovery.He was discharged 11 days later.CONCLUSION VA-ECMO can serve as a bridging resuscitation technique for patients with reversible malignant arrhythmias.展开更多
The purpose of this study is to investigate the impact of veno-arterial(VA)ECMO cannulation on hemodynamic distribution and organ perfusion within aorta under differential blood perfusion conditions.The total blood fl...The purpose of this study is to investigate the impact of veno-arterial(VA)ECMO cannulation on hemodynamic distribution and organ perfusion within aorta under differential blood perfusion conditions.The total blood flow volume supplied by failure heart and ECMO keep constant,flow volume ratio of heart output(FVR-HO)increases from 0%to 100%and correspondingly flow volume ratio of ECMO(FVR-ECMO)decreases from 100%to 0%.The flow patterns within aorta,wall shear stress(WSS),oscillatory shear index(OSI),relative retention time(RRT)were analyzed.The locations of oxygenated and de-oxygenated blood mixing region(BMR)was influenced by FVR-HO.With FVR-HO increasing,BMR moves from proximal to distal side of heart.When FVR-HO was 0%,oxygenated blood supplied by ECMO completely perfuses the aortic vessels.High WSS appears in the iliac artery and abdominal aorta vessel walls closed to cannula position.When FVR-HO was in the range of 10%–30%,the BMR was in aortic arch.The higher OSI and RRT were exhibited in ascending aorta and aorta arch.When FVR-HO was 40%and 50%,the BMR was in ventral trunk for systolic period and in aortic arch for diastolic period.The higher OSI and RRT regions enlarge and metastasize to the descending aorta.When FVR-HO was larger than 50%,the BMR was in the downstream region of the renal artery.Of note,when FVR-HO increases from 0%to 100%,the flow ratios in the two renal arteries change from significant different to be closed at systolic period.Peripheral VA-ECMO with various perfusion levels from cardiac output and ECMO has significant effect on aortic flow surrounding.Partial recovery of heart function can impel BMR moves from proximal to distal side of the heart,which may lead to inadequate supply of oxygenated blood to the upper limb and cephalic vessels.展开更多
文摘BACKGROUND Most species of aconite contain highly toxic aconitines,the oral ingestion of which can be fatal,primarily because they cause ventricular arrhythmias.We describe a case of severe aconite poisoning that was successfully treated through venoarterial extracorporeal membrane oxygenation(VA-ECMO)and in which detailed toxicological analyses of the aconite roots and biological samples were performed using liquid chromatography-tandem mass spectrometry(LC-MS/MS).CASE SUMMARY A 23-year-old male presented to the emergency room with circulatory collapse and ventricular arrhythmia after ingesting approximately half of a root labeled,“Aconitum japonicum Thunb”.Two hours after arrival,VA-ECMO was initiated as circulatory collapse became refractory to antiarrhythmics and vasopressors.Nine hours after arrival,an electrocardiogram revealed a return to sinus rhythm.The patient was weaned off VA-ECMO and the ventilator on hospital days 3 and 5,respectively.On hospital day 15,he was transferred to a psychiatric hospital.The other half of the root and his biological samples were toxicologically analyzed using LC-MS/MS,revealing 244.3 mg/kg of aconitine and 24.7 mg/kg of mesaconitine in the root.Serum on admission contained 1.50 ng/mL of aconitine.Beyond hospital day 2,neither were detected.Urine on admission showed 149.09 ng/mL of aconitine and 3.59 ng/mL of mesaconitine,but these rapidly decreased after hospital day 3.CONCLUSION The key to saving the life of a patient with severe aconite poisoning is to introduce VA-ECMO as soon as possible.
基金Construction and Application of Management Program for Prevention and Treatment of Inpatients with Venous Thromboembolism,No.WFWSJK-2022-111and Shandong Provincial Medical and Health Science and Technology Development Program,No.202103050856.
文摘BACKGROUND Venous air embolism(VAE)is a potentially lethal condition,with a reported incidence rate of about 0.13%,and the true incidence may be higher since many VAE are asymptomatic.The current treatments for VAE include Durant's maneuver,aspiration and removal of air through venous catheters,and hyperbaric oxygen therapy.For critically ill patients,use of cardiotonic drugs and chest compressions remain useful strategies.The wider availability of extracorporeal membrane oxygenation(ECMO)has brought a new option for VAE patients.CASE SUMMARY A 53-year-old female patient with VAE presented to the emergency clinic due to abdominal pain with fever for 1 d and unconsciousness for 2 h.One day ago,the patient suffered from abdominal pain,fever,and diarrhea.She suddenly became unconscious after going to the toilet during the intravenous infusion of ciprofloxacin 2 h ago,accompanied by nausea and vomiting,during which a small amount of gastric contents were discharged.She was immediately sent to a local hospital,where cranial and chest computed tomography showed bilateral pneumonia as well as accumulated air visible in the right ventricle and pulmonary artery.The condition deteriorated despite endotracheal intubation,rehydration,and other treatments,and the patient was then transferred to our hospital.Veno-arterial ECMO was applied in our hospital,and the patient's condition gradually improved.The patient was successfully weaned from ECMO and extubated after two days.CONCLUSION ECMO may be an important treatment for patients with VAE in critical condition.
文摘BACKGROUND Aconitine poisoning is highly prone to causing malignant arrhythmias.The elimination of aconitine from the body takes a considerable amount of time,and during this period,patients are at a significant risk of death due to malignant arrhythmias associated with aconitine poisoning.CASE SUMMARY A 30-year-old male patient was admitted due to accidental ingestion of aconitinecontaining drugs.Upon arrival at the emergency department,the patient intermittently experienced malignant arrhythmias including ventricular tachycardia,ventricular fibrillation,ventricular premature beats,and cardiac arrest.Emergency interventions such as cardiopulmonary resuscitation and defibrillation were promptly administered.Additionally,veno-arterial extracorporeal membrane oxygenation(VA-ECMO)therapy was initiated.Successful resuscitation was achieved before ECMO placement,but upon initiation of ECMO,the patient experienced recurrent malignant arrhythmias.ECMO was utilized to maintain hemodynamics and respiration,while continuous blood purification therapy for toxin clearance,mechanical ventilation,and hypothermic brain protection therapy were concurrently administered.On the third day of VA-ECMO support,the patient’s respiratory and hemodynamic status stabilized,with only frequent ventricular premature beats observed on electrocardiographic monitoring,and echocardiography indicated recovery of cardiac contractile function.On the fourth day,a significant reduction in toxin levels was observed,along with stable hemodynamic and respiratory functions.Following a successful pump-controlled retrograde trial occlusion test,ECMO assistance was terminated.The patient gradually improved postoperatively and achieved recovery.He was discharged 11 days later.CONCLUSION VA-ECMO can serve as a bridging resuscitation technique for patients with reversible malignant arrhythmias.
基金the National Key R&D Program of China(Grant no.2020YFC0862900,2020YFC0862902,2020YFC0862904 and 2020YFC0122203)the Beijing Municipal Science and Technology Project(Grant no.Z201100007920003)the National Natural Science Foundation of China(Grant no.32071311).
文摘The purpose of this study is to investigate the impact of veno-arterial(VA)ECMO cannulation on hemodynamic distribution and organ perfusion within aorta under differential blood perfusion conditions.The total blood flow volume supplied by failure heart and ECMO keep constant,flow volume ratio of heart output(FVR-HO)increases from 0%to 100%and correspondingly flow volume ratio of ECMO(FVR-ECMO)decreases from 100%to 0%.The flow patterns within aorta,wall shear stress(WSS),oscillatory shear index(OSI),relative retention time(RRT)were analyzed.The locations of oxygenated and de-oxygenated blood mixing region(BMR)was influenced by FVR-HO.With FVR-HO increasing,BMR moves from proximal to distal side of heart.When FVR-HO was 0%,oxygenated blood supplied by ECMO completely perfuses the aortic vessels.High WSS appears in the iliac artery and abdominal aorta vessel walls closed to cannula position.When FVR-HO was in the range of 10%–30%,the BMR was in aortic arch.The higher OSI and RRT were exhibited in ascending aorta and aorta arch.When FVR-HO was 40%and 50%,the BMR was in ventral trunk for systolic period and in aortic arch for diastolic period.The higher OSI and RRT regions enlarge and metastasize to the descending aorta.When FVR-HO was larger than 50%,the BMR was in the downstream region of the renal artery.Of note,when FVR-HO increases from 0%to 100%,the flow ratios in the two renal arteries change from significant different to be closed at systolic period.Peripheral VA-ECMO with various perfusion levels from cardiac output and ECMO has significant effect on aortic flow surrounding.Partial recovery of heart function can impel BMR moves from proximal to distal side of the heart,which may lead to inadequate supply of oxygenated blood to the upper limb and cephalic vessels.
