Page 31 - HA Convention 2016 [Abstracts (Day 1)]

Masterclasses HOSPITAL AUTHORITY CONVENTION 2016

M4.1 Extracorporeal Membrane Oxygenation Services 14:30 Convention Hall A

Extracorporeal Membrane Oxygenation in Cardiological Practices Tuesday, 3 May
Chan KT
Cardiac Catheterization Laboratory, Queen Elizabeth Hospital, Hong Kong

A wide range of patients with acute coronary syndrome, myocarditis, severe valvular heart diseases and cardiomyopathy can
present acutely with fulminant heart failure or cardiogenic shock, resulting in a very high mortality and morbidity. It is very
important to provide temporary support of the hemodynamic and oxygenation status of these patients to allow adequate
time for definitive treatment and recovery of the diseased organs. Inotropic drugs (adrenaline, noradrenaline, dobutamine,
dopamine) have severe limitation in their efficacy and associated side effects. Intraaortic Balloon Counterpulsation (IABP) with
the helium-filled balloon put in the descending aorta, can reduce the afterload and improve the perfusion to the major organs.
However, recent clinical trials have failed to show any significant improvement in outcomes of these patients. Extracorporeal
Membrane Oxygenation (ECMO) has been used in these critically ill cardiac patients and can be an effective alternative
therapy.

There are essentially two types of ECMO systems — Veno-Arterial (VA) or Veno-Veno (VV) ECMO systems. VV ECMO does
not provide circulatory support and usually used for patients with severe respiratory system disorders. VA ECMO draws
deoxygenated blood from the right atrium or central veins, then passes through the artificial membrane oxygenator and then
returns to the patient through the arterial catheter. The VA ECMO system can support the circulation up to 5L per minute
and is effective in patients with severely impaired myocardial function. It is also a very effective life saving modality to rescue
patients who develop catastrophic complications in the cardiac catheterisation laboratory. Common complications of ECMO
include infection, thromboembolism; bleeding and vascular access and limbs complications. The insertion of a 7F or 8F
reperfusion catheters to the lower limb after ECMO can improve circulation to the extremities and significantly reduce the
ischemic and amputation rate. Colleagues from Queen Mary Hospital have applied a multidisciplinary approach with joint
efforts of intensive care clinicians, cardiologists and Accident and Emergency Department (AED) specialists and initiate VA
ECMO therapy in AED for selected patients with out-of-hospital cardiac arrest. This can improve the successful resuscitation
of these very ominous patients and expand the scope of ECMO services in our locality.

M4.2 Extracorporeal Membrane Oxygenation Services 14:30 Convention Hall A

Update on Recent Advances in Treating Beta-blocker and Calcium Channel Blocker Overdose
Chan YC
Department of Clinical Toxicology, United Christian Hospital, Hong Kong

The cardiovascular drug class, especially calcium channel blocker (CCB) and beta-blocker (BB), is one of the leading drug
classes associated with poisoning fatality. The Hong Kong Poison Information Centre recorded 100 to 150 cases of CCB or/
and BB poisoning per year in the past three years (2013-2015) which resulted in a total of 19 deaths. Preventing critically ill
patient from CCB/BB overdose is challenging. In general, treatment can be divided into supportive care, gastrointestinal
decontamination, use of standard (calcium, glucagon and vasopressor) and other antidotes, enhanced elimination, and
extracorporeal life support (ECLS).

The presentation will focus on recent advances/evidences regarding the following treatments:

(1) High-dose insulin-euglycaemia (HIE) therapy which was found to be associated with improved haemodynamic
parameters and lower mortality. Although no human controlled trial is available, the evidence derived from observation
studies, case series/reports support the use of HIE in CCB/BB poisoning.

(2) Intravenous lipid emulsion (ILE) therapy has been utilised in CCB/BB overdose although its benefit is only supported by
animal data and human case series/reports. It can be considered in severe CCB/lipophilic BB poisoning.

(3) ECLS was found to be associated with survival benefit in patients with severe shock or cardiac arrest based on an
observational study and case series/reports.

(4) Case series/reports on enhanced elimination in severe CCB/BB poisoning.

(5) A brief review on other investigational treatments such as levosimendan, methylene blue, carnitine, fructose 1,
6-diphosphate.

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