Refractory Anaphylactic Shock Requiring Emergent Venoarterial Extracorporeal Membrane Oxygenation in the Emergency Department: A Case Report

Published:September 13, 2022DOI:https://doi.org/10.1016/j.jen.2022.08.002

      Abstract

      Venoarterial extracorporeal membrane oxygenation is a viable salvage intervention for patients who experience cardiopulmonary arrest or profound shock from any cause. Acute anaphylactic shock is a rare cause of cardiac arrest. We present a case of a 35-year-old male who experienced cardiac arrest owing to anaphylactic shock while receiving general anesthesia for a routine outpatient surgical procedure. Traditional advanced cardiac life support therapies were provided by paramedics en route to the emergency department of a suburban, community-based hospital. Maximal medical management including endotracheal intubation, intravenous steroids, intravenous crystalloid fluid administration, intravenous vasoactive medications, and high-quality cardiopulmonary resuscitation was provided. Although return of spontaneous circulation was achieved, profound cardiogenic shock persisted. Venoarterial extracorporeal membrane oxygenation was initiated by the emergency department provider and nursing team. The patient survived, was neurologically intact, had full recovery, and was discharged home several days later. We have extensive experience with venoarterial extracorporeal membrane oxygenation, and this case exemplifies the value of an established emergency department extracorporeal membrane oxygenation program in managing all causes of cardiac arrest or refractory shock.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Weingart S. EMCrit 256–RUSH redux with Jacob Avila. EMCrit Blog. Posted September 18, 2019. Accessed June 25, 2022. https://emcrit.org/emcrit/rush-redux/

        • Motosue M.S.
        • Li J.T.
        • Campbell R.L.
        Anaphylaxis: epidemiology and differential diagnosis.
        Immunol Allergy Clin North Am. 2022; 42: 13-25https://doi.org/10.1016/j.iac.2021.09.010
        • Tejedor Alonso M.A.
        • Moro Moro M.
        • Múgica García M.V.
        Epidemiology of anaphylaxis.
        Clin Exp Allergy. 2015; 45: 1027-1039https://doi.org/10.1111/cea.12418
        • Lieberman P.
        Anaphylactic reactions during surgical and medical procedures.
        J Allergy Clin Immunol. 2002; 110: S64-S69https://doi.org/10.1067/mai.2002.124970
        • Castells M.
        Diagnosis and management of anaphylaxis in precision medicine.
        J Allergy Clin Immunol. 2017; 140: 321-333https://doi.org/10.1016/j.jaci.2017.06.012
        • Kelkar P.S.
        • Li J.T.
        Cephalosporin allergy.
        N Engl J Med. 2001; 345: 804-809https://doi.org/10.1056/NEJMra993637
        • Annè S.
        • Reisman R.E.
        Risk of administering cephalosporin antibiotics to patients with histories of penicillin allergy.
        Ann Allergy Asthma Immunol. 1995; 74: 167-170
        • Lafç G.
        • Budak A.B.
        • Yener A.Ü.
        • Cicek O.F.
        Use of extracorporeal membrane oxygenation in adults.
        Heart Lung Circ. 2014; 23: 10-23https://doi.org/10.1016/j.hlc.2013.08.009
        • Mattox K.L.
        • Beall Jr., A.C.
        Resuscitation of the moribund patient using portable cardiopulmonary bypass.
        Ann Thorac Surg. 1976; 22: 436-442https://doi.org/10.1016/S0003-4975(10)64452-9
        • Bellezzo J.M.
        • Shinar Z.
        • Davis D.P.
        • et al.
        Emergency physician-initiated extracorporeal cardiopulmonary resuscitation.
        Resuscitation. 2012; 83: 966-970https://doi.org/10.1016/j.resuscitation.2012.01.027
        • Dennis M.
        • Lal S.
        • Forrest P.
        • et al.
        In-depth extracorporeal cardiopulmonary resuscitation in adult out-of-hospital cardiac arrest.
        J Am Heart Assoc. 2020; 9e016521https://doi.org/10.1161/JAHA.120.016521
        • Johnston L.
        • Williams S.B.
        • Ades A.
        Education for ECMO providers: using education science to bridge the gap between clinical and educational expertise.
        Semin Perinatol. 2018; 42: 138-146https://doi.org/10.1053/j.semperi.2017.12.010
        • Tonna J.E.
        • Johnson N.J.
        • Greenwood J.
        • et al.
        Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: the current state of the art of emergency department extracorporeal membrane oxygenation (ED ECMO).
        Resuscitation. 2016; 107: 38-46https://doi.org/10.1016/j.resuscitation.2016.07.237
        • Yannopoulos D.
        • Bartos J.
        • Raveendran G.
        • et al.
        Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial.
        Lancet. 2020; 396: 1807-1816https://doi.org/10.1016/S0140-6736(20)32338-2
      2. Weingart S. Podcast 204–the nurse-led code with Joe Bellezzo. EMCrit Blog. Posted July 24, 2017. Accessed June 22, 2022. https://emcrit.org/emcrit/nurse-led-code/

      Biography

      Jese Joseph is an Advanced Clinician/Registered Nurse, Sharp Memorial Emergency Department, San Diego, CA. ORCID identifier: http://orcid.org/0000-0003-4722-6309. ENA ID: 1356959.

      Biography

      Joseph Bellezzo is a Physician, Sharp Memorial Emergency Department, San Diego, CA. Twitter: @drbellezzo . ORCID identifier: http://orcid.org/0000-0002-4653-5911.