title: Extracorporeal support in an adult with severe carbon monoxide poisoning and shock following smoke inhalation: a case report.
abstract: The objective of this study was to discuss the case of a patient with severe smoke inhalation-related respiratory failure treated with extracorporeal support. The study was set in a 12-bed multi-trauma intensive care unit at a level one trauma center and hyperbaric medicine center. The patient under investigation had carbon monoxide poisoning, and developed acute respiratory distress syndrome and cardiovascular collapse following smoke inhalation. Rapid initiation of extracorporeal support, extreme inverse-ratio ventilation and intermittent prone positioning therapy were carried out. Admission and serial carboxyhemoglobin levels, blood gases, and computerized tomography of the chest were obtained. The patient developed severe hypoxia and progressed to cardiovascular collapse resistant to resuscitation and vasoactive infusions. Veno-venous extracorporeal support was initiated. Cardiovascular parameters of blood pressure, cardiac output, and oxygen delivery were maximized; oxygenation and ventilation were supported via the extracorporeal circuit. Airway pressure release ventilation and intermittent prone positioning therapy were instituted. Following 7 days of extracorporeal support, the patient was decannulated and subsequently discharged to a transitional care facility,neurologically intact. Smoke inhalation and carbon monoxide poisoning may lead to life-threatening hypoxemia associated with resultant cardiovascular instability. When oxygenation and ventilation cannot be achieved via maximal ventilatory management, extracorporeal support may prevent death if initiated rapidly.
authors.affiliation: Department of Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore 21201, USA. mmccunn@stc1.unmc.umaryland.edu
authors.forename: M
authors.initials: M
authors.lastname: McCunn
authors.forename: H N
authors.initials: HN
authors.lastname: Reynolds
authors.forename: C A
authors.initials: CA
authors.lastname: Cottingham
authors.forename: T M
authors.initials: TM
authors.lastname: Scalea
authors.forename: N M
authors.initials: NM
authors.lastname: Habashi
mesh_terms: D000328:Adult; D001999:Bronchoscopy; D002249:Carbon Monoxide Poisoning / Q000209:etiology / Q000628:therapy*; D002263:Carboxyhemoglobin / Q000032:analysis; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation; D005390:Fires; D006439:Hemodynamics; D006801:Humans; D006931:Hyperbaric Oxygenation; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011175:Positive-Pressure Respiration; D016684:Prone Position; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*; D015208:Smoke Inhalation Injury / Q000628:therapy*; D014057:Tomography, X-Ray Computed
chemical_list: D002263:Carboxyhemoglobin; D010100:Oxygen