A 31-year-old male was transferred to our hospital with severe heart failure due to viral myocarditis. He progressed to multiorgan failure requiring intubation and maximal doses of multiple vasopressors. Circulatory support was provided with an Impella device as a bridge to an extracorporeal membrane oxygenation (ECMO) system. On full mechanical cardiovascular support, the patient's hemodynamic status improved and ECMO and Impella were explanted after 48 hours. Three days later, he was extubated and continued on to a full recovery. There are no specific therapies for fulminant myocarditis but first-line treatment is supportive care. ECMO is commonly used in patients with severe heart failure. In severe systolic dysfunction, left ventricular decompression is required to reduce myocardial wall stress, decrease myocardial oxygen requirements, and enhance the chances of recovery. The Impella, an active support system, is less invasive than classical decompressive techniques and is associated with lower requirements for blood products with fewer thromboembolic complications. This is the only case reported of the contemporary use of Impella and ECMO as a bridge to full recovery in an adult with myocarditis. It also presents a novel use of the Impella device in decompressing the left ventricle of an adult patient on ECMO.

Sachin Narain

Gian Paparcuri

Thomas M. Fuhrman

Richard B. Silverman

William T. Peruzzi

Novel Combination of Impella and Extra Corporeal Membrane Oxygenation as a Bridge to Full Recovery in Fulminant Myocarditis

Background. Acute hepatic failure (AHF) is uncommon as a leading symptom in patients with exertional heat stroke (EHS). Which stage to perform the liver transplantation for severe hepatic failure in EHS is still obscure at clinical setting. The conservative management has been reported to be successful in treating heat-stroke-associated AHF even in the presence of accepted criteria for emergency liver transplantation. Case Presentation. Here, we reported a 35-year-old male who presented with very high transaminases, hyperbilirubinemia, significant prolongation of the prothrombin time, and coma. No other causes for AHF could be identified but physical exhaustion and hyperthermia. Although the current patient fulfilled London criteria for emergency liver transplantation, he spontaneously recovered under conservative treatment including intravenous fluids, cooling, diuretics as mannitol, and hepatocyte growth-promoting factors. Conclusions. Meticulous supportive management could be justified in some selected cases of AHF due to EHS.

Qi Jin

Erzhen Chen

Jie Jiang

Yiming Lu

Acute Hepatic Failure as a Leading Manifestation in Exertional Heat Stroke

Serum troponin is a useful laboratory study for the diagnosis of acute myocardial infarction. However, elevations can also be seen in a variety of other diseases processes. Falsely positive troponin values caused by interference with current troponin assays have been reported. We report a unique case that demonstrates the fluctuation of falsely elevated troponin correlating with hemoglobin, serving as a marker of heterophile antibody levels. A 74-year-old gentleman presented to our Emergency Department with a several-day history of increasing shortness of breath associated with a new-onset chest pain and a troponin I level of 77.28&#x2009;ng/mL. Throughout his stay, fluctuations in measured troponin levels correlated strongly with fluctuations in hemoglobin levels. Several investigations confirmed false elevated troponin levels secondary to heterophile antibody interference. We conclude that hemoglobin trending in our patient represented a surrogate measure of his heterophile antibody titers with time and that fluctuations in these levels correlated with respective fluctuations in the falsely elevated troponin levels.

Sam Ghali

Keith Lewis

Viviane Kazan

Neezam Altorok

Jamil Taji

Mohammad Taleb

Kiranmayee Lanka

Ragheb Assaly

Fluctuation of Spuriously Elevated Troponin I: A Case Report

The complications associated with central venous catheterization are common and well known. Common malplacement locations have been described in the literature. We report the case of a direct puncture of the pulmonary artery during a subclavian central venous catheterization.

J&#233;r&#244;me Moriceau

Vincent Comp&#232;re

Marc Bigo

Bertrand Dureuil

Accidental Puncture of the Pulmonary Artery during a Subclavian Central Venous Catheterization

Rhabdomyolysis is a syndrome caused by skeletal muscle cells destruction which can occur for many reasons, including prolonged immobilization. The main complication of the syndrome is the development of acute renal failure. Rhabdomyolysis and myoglobinuria are responsible for approximately 5% of all causes of acute renal failure in the USA. The cause of rhabdomyolysis is often multifactorial, and approximately 8–20% of such patients develop myoglobinuric acute renal failure.

G. Maggi

F. Quinteros Hinojosa

M. J. Villagran

E. Guasch Arévalo

F. Gilsanz Rodríguez

Renal Replacement Therapy in Acute Kidney Failure due to Rhabdomyolysis

Calcium channel antagonists (CCAs) are commonly involved in drug overdoses. Standard approaches to the management of CCA overdoses, including fluid resuscitation, gut decontamination, administration of calcium, glucagon, and atropine, as well as supportive care, are often ineffective. We report on two patients who improved after addition of hyperinsulinemia-euglycemia (HIE) therapy. We conclude with a literature review on hyperinsulinemia-euglycemia therapy with an exploration of the physiology behind its potential use.

Shiwan K. Shah

Sanjeev Kumar Goswami

Rajesh V. Babu

Gulshan Sharma

Alexander G. Duarte

Management of Calcium Channel Antagonist Overdose with Hyperinsulinemia-Euglycemia  Therapy:  Case Series and Review of the Literature

Introduction. Neurogenic stunned myocardium (NSM) is a reversible cardiomyopathy resulting in transient left ventricular apical ballooning presumed to result from catecholamine surge occurring under physiologic stress. Acute spinal cord ischemia is a rare ischemic vascular lesion. We report a case of neurogenic stunned myocardium occurring in the setting of acute spinal cord infarction. Methods. Singe case report was used. Results. We present the case of a 63-year-old female with a history of prior lacunar stroke, hypertension, chronic back pain, and hypothyroidism who presented with a brief episode of diffuse abdominal and bilateral lower extremity pain which progressed within minutes to bilateral lower extremity flaccid paralysis. MRI of the spinal cord revealed central signal hyperintensity of T2-weighted imaging from conus to T8 region, concerning for acute spinal cord ischemia. Transthoracic echocardiogram was performed to determine if a cardiac embolic phenomenon may have precipitated this ischemic event and showed left ventricular apical hypokinesis and ballooning concerning for NSM. Conclusion. Neurogenic stunned myocardium is a reversible cardiomyopathy which has been described in patients with physiologic stress resulting in ventricular apical ballooning. Our case suggests that it is possible for neurogenic stunned myocardium to occur in the setting of acute spinal cord ischemia.

Gillian A. Beauchamp

Jason T. McMullan

Jordan B. Bonomo

Neurogenic Stunned Myocardium Associated with Acute Spinal Cord Infarction: A Case Report

Enteral feeding is still the preferred method of nutritional support even in patients with excessive body mass index. Often, this mass poses a hindrance in performing routine procedures. We present a case describing the technique used to safely place a fluoroscopically guided G-tube in a patient with a significant nutritional deficit after repair of a ruptured thoracic aneurysm. Her admission weight was in excess of 180&#x2009;Kg. However, protracted respiratory insufficiency and mechanical ventilation prolonged her hospital course. The G-tube was successfully placed using a fluoroscopically guided technique. The advantages of such an approach are discussed.

Irwin M. Best

Technique for Percutaneous Fluoroscopically Guided G-Tube Placement in a High-BMI Patient

About this journal

Case Reports in Critical Care publishes case reports and case series in all areas of critical care medicine, including anesthesiology, perioperative and critical care medicine, and postoperative critical care management and recovery.

Journal profile

Meet the editorial board

Case Reports in Critical Care maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.

Editor spotlight

Find out more

This journal's articles appear in a wide range of abstracting and indexing databases, and are covered by numerous other services that aid discovery and access. Find out more about where and how the content of this journal is available.

Abstracting and Indexing

Author guidelines

Editorial board

Databases and indexing

Case Reports in Critical Care - Table of contents 2012

title

Case Reports in Critical Care publishes case reports and case series in all areas of critical care medicine, including anesthesiology, perioperative and critical care medicine, and postoperative critical care management and recovery.

Case Reports in Critical Care